- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $684.46 / $2,618.00 / $3,469.00
| Facility | | $684.46 | $2,618.00 | $3,469.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $594.53 / $706.37 / $1,725.85
| Professional | | $594.53 | $706.37 | $1,725.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $941.10 / $3,764.00 / $26,542.00
| Facility | | $941.10 | $3,764.00 | $26,542.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $686.09 / $1,355.86 / $5,066.64
| Professional | | $686.09 | $1,355.86 | $5,066.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $978.14 / $1,351.01 / $1,824.47
| Professional | | $978.14 | $1,351.01 | $1,824.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,770.00 / $1,947.00 / $3,111.82
| Facility | | $1,770.00 | $1,947.00 | $3,111.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $557.79 / $1,158.39 / $2,447.14
| Professional | | $557.79 | $1,158.39 | $2,447.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $506.00 / $1,497.52 / $6,679.00
| Facility | | $506.00 | $1,497.52 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $797.90 / $1,010.83 / $1,481.07
| Professional | | $797.90 | $1,010.83 | $1,481.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $863.03 / $1,703.62 / $2,149.46
| Professional | | $863.03 | $1,703.62 | $2,149.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,061.00 / $4,249.00 / $26,542.00
| Facility | | $1,061.00 | $4,249.00 | $26,542.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $729.73 / $1,378.48 / $5,066.64
| Professional | | $729.73 | $1,378.48 | $5,066.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,061.00 / $2,854.00 / $5,714.00
| Facility | | $1,061.00 | $2,854.00 | $5,714.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $710.99 / $1,038.79 / $2,397.21
| Professional | | $710.99 | $1,038.79 | $2,397.21 |