- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,421.00 / $2,618.00 / $4,605.00
| Facility | | $1,421.00 | $2,618.00 | $4,605.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $600.25 / $838.40 / $2,103.40
| Professional | | $600.25 | $838.40 | $2,103.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,089.00 / $3,315.28 / $8,498.00
| Facility | | $1,089.00 | $3,315.28 | $8,498.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $678.62 / $1,199.43 / $5,764.80
| Professional | | $678.62 | $1,199.43 | $5,764.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $892.98 / $1,357.04 / $2,780.55
| Professional | | $892.98 | $1,357.04 | $2,780.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $793.00 / $1,706.68 / $6,679.00
| Facility | | $793.00 | $1,706.68 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $876.27 / $1,088.01 / $1,501.88
| Professional | | $876.27 | $1,088.01 | $1,501.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $987.96 / $1,872.18 / $2,797.98
| Professional | | $987.96 | $1,872.18 | $2,797.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,600.77 / $2,941.55 / $5,529.27
| Facility | | $1,600.77 | $2,941.55 | $5,529.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,640.00 / $4,525.00 / $16,394.00
| Facility | | $1,640.00 | $4,525.00 | $16,394.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $805.56 / $1,235.48 / $5,764.80
| Professional | | $805.56 | $1,235.48 | $5,764.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,640.00 / $3,372.00 / $8,425.00
| Facility | | $1,640.00 | $3,372.00 | $8,425.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $687.09 / $1,113.66 / $2,245.42
| Professional | | $687.09 | $1,113.66 | $2,245.42 |