- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $728.00 / $3,698.58 / $4,114.84
| Facility | | $728.00 | $3,698.58 | $4,114.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $728.00 / $728.00 / $2,079.29
| Professional | | $728.00 | $728.00 | $2,079.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $997.60 / $2,349.33 / $6,413.40
| Facility | | $997.60 | $2,349.33 | $6,413.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $737.13 / $1,350.19 / $5,070.00
| Professional | | $737.13 | $1,350.19 | $5,070.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15.60 / $2,888.29 / $5,364.58
| Facility | | $15.60 | $2,888.29 | $5,364.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,242.17 / $1,242.17 / $1,242.17
| Professional | | $1,242.17 | $1,242.17 | $1,242.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $877.62 / $965.38 / $2,632.33
| Facility | | $877.62 | $965.38 | $2,632.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $675.10 / $1,214.49 / $6,024.36
| Professional | | $675.10 | $1,214.49 | $6,024.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $83.43 / $4,618.00 / $9,239.00
| Facility | | $83.43 | $4,618.00 | $9,239.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,948.20 / $1,948.20 / $2,292.00
| Professional | | $1,948.20 | $1,948.20 | $2,292.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,350.19 / $1,350.19 / $4,131.58
| Professional | | $1,350.19 | $1,350.19 | $4,131.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,274.32 / $1,274.32 / $1,274.32
| Facility | | $1,274.32 | $1,274.32 | $1,274.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,349.33 / $6,413.40 / $6,413.40
| Facility | | $2,349.33 | $6,413.40 | $6,413.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $607.59 / $810.11 / $6,750.95
| Professional | | $607.59 | $810.11 | $6,750.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $567.08 / $810.11 / $2,025.29
| Professional | | $567.08 | $810.11 | $2,025.29 |