- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $964.43 / $2,747.00 / $7,625.00
| Facility | | $964.43 | $2,747.00 | $7,625.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $545.29 / $707.85 / $2,246.67
| Professional | | $545.29 | $707.85 | $2,246.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $828.24 / $5,268.00 / $15,220.00
| Facility | | $828.24 | $5,268.00 | $15,220.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $380.89 / $794.16 / $7,725.84
| Professional | | $380.89 | $794.16 | $7,725.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $129.37 / $271.64 / $1,086.56
| Professional | | $129.37 | $271.64 | $1,086.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $405.87 / $736.56 / $1,309.05
| Professional | | $405.87 | $736.56 | $1,309.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $348.31 / $740.64 / $6,679.00
| Facility | | $348.31 | $740.64 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $214.66 / $409.20 / $644.37
| Professional | | $214.66 | $409.20 | $644.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $438.27 / $874.09 / $1,278.13
| Professional | | $438.27 | $874.09 | $1,278.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,522.08 / $5,101.49 / $10,179.94
| Facility | | $1,522.08 | $5,101.49 | $10,179.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $560.67 / $727.15 / $1,092.36
| Professional | | $560.67 | $727.15 | $1,092.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,646.95 / $6,104.00 / $26,542.00
| Facility | | $1,646.95 | $6,104.00 | $26,542.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $486.91 / $838.62 / $7,725.84
| Professional | | $486.91 | $838.62 | $7,725.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,155.00 / $4,983.00 / $8,810.00
| Facility | | $2,155.00 | $4,983.00 | $8,810.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $466.60 / $721.01 / $1,254.61
| Professional | | $466.60 | $721.01 | $1,254.61 |