- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $711.51 / $2,747.00 / $5,039.00
| Facility | | $711.51 | $2,747.00 | $5,039.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $682.02 / $796.65 / $1,209.65
| Professional | | $682.02 | $796.65 | $1,209.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $541.00 / $3,245.00 / $13,486.75
| Facility | | $541.00 | $3,245.00 | $13,486.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $778.66 / $1,535.05 / $7,231.97
| Professional | | $778.66 | $1,535.05 | $7,231.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,024.54 / $1,519.12 / $2,057.89
| Professional | | $1,024.54 | $1,519.12 | $2,057.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $50.00 / $680.00 / $748.00
| Facility | | $50.00 | $680.00 | $748.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $648.82 / $1,320.82 / $2,773.38
| Professional | | $648.82 | $1,320.82 | $2,773.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $300.00 / $1,266.83 / $6,679.00
| Facility | | $300.00 | $1,266.83 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $902.88 / $1,140.89 / $1,675.93
| Professional | | $902.88 | $1,140.89 | $1,675.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $992.87 / $1,959.93 / $2,472.84
| Professional | | $992.87 | $1,959.93 | $2,472.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,260.78 / $1,260.78 / $1,260.78
| Professional | | $1,260.78 | $1,260.78 | $1,260.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $4,287.00 / $13,486.75
| Facility | | $55.00 | $4,287.00 | $13,486.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $837.28 / $1,570.89 / $7,231.97
| Professional | | $837.28 | $1,570.89 | $7,231.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,485.00 / $3,245.00 / $7,608.00
| Facility | | $1,485.00 | $3,245.00 | $7,608.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $805.41 / $1,172.70 / $2,569.50
| Professional | | $805.41 | $1,172.70 | $2,569.50 |