- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $801.75 / $2,447.48 / $4,410.00
| Facility | | $801.75 | $2,447.48 | $4,410.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $515.51 / $726.78 / $1,719.30
| Professional | | $515.51 | $726.78 | $1,719.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,089.00 / $3,303.20 / $8,498.00
| Facility | | $1,089.00 | $3,303.20 | $8,498.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $619.53 / $1,247.58 / $4,719.43
| Professional | | $619.53 | $1,247.58 | $4,719.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $775.71 / $1,008.42 / $1,779.48
| Facility | | $775.71 | $1,008.42 | $1,779.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $977.44 / $1,392.32 / $2,029.85
| Professional | | $977.44 | $1,392.32 | $2,029.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $753.18 / $1,205.38 / $2,467.37
| Professional | | $753.18 | $1,205.38 | $2,467.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $653.58 / $1,414.42 / $6,679.00
| Facility | | $653.58 | $1,414.42 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $902.33 / $1,136.19 / $1,568.39
| Professional | | $902.33 | $1,136.19 | $1,568.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $811.83 / $1,674.63 / $2,484.19
| Professional | | $811.83 | $1,674.63 | $2,484.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,531.33 / $1,531.33 / $2,278.62
| Facility | | $1,531.33 | $1,531.33 | $2,278.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,640.00 / $3,372.00 / $26,542.00
| Facility | | $1,640.00 | $3,372.00 | $26,542.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $858.17 / $1,512.75 / $5,852.72
| Professional | | $858.17 | $1,512.75 | $5,852.72 |
- 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
- $671.04 / $1,105.51 / $2,420.69
| Professional | | $671.04 | $1,105.51 | $2,420.69 |