- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $816.96 / $2,081.00 / $4,410.00
| Facility | | $816.96 | $2,081.00 | $4,410.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $431.74 / $634.00 / $1,833.90
| Professional | | $431.74 | $634.00 | $1,833.90 |
- 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
- $540.27 / $1,088.90 / $4,135.35
| Professional | | $540.27 | $1,088.90 | $4,135.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $680.11 / $884.14 / $1,560.17
| Facility | | $680.11 | $884.14 | $1,560.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $953.51 / $1,246.91 / $1,773.11
| Professional | | $953.51 | $1,246.91 | $1,773.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $647.41 / $1,051.26 / $2,156.00
| Professional | | $647.41 | $1,051.26 | $2,156.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $571.54 / $1,240.11 / $6,679.00
| Facility | | $571.54 | $1,240.11 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $786.65 / $992.49 / $1,370.02
| Professional | | $786.65 | $992.49 | $1,370.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $704.92 / $1,452.63 / $2,172.92
| Professional | | $704.92 | $1,452.63 | $2,172.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,115.38 / $4,115.38 / $4,501.87
| Facility | | $4,115.38 | $4,115.38 | $4,501.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,640.00 / $3,919.32 / $26,542.00
| Facility | | $1,640.00 | $3,919.32 | $26,542.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $745.86 / $1,311.17 / $5,111.20
| Professional | | $745.86 | $1,311.17 | $5,111.20 |
- 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
- $597.63 / $1,014.97 / $2,115.94
| Professional | | $597.63 | $1,014.97 | $2,115.94 |