- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $662.62 / $2,747.00 / $7,596.04
| Facility | | $662.62 | $2,747.00 | $7,596.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $567.03 / $809.37 / $2,374.42
| Professional | | $567.03 | $809.37 | $2,374.42 |
- 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
- $662.93 / $1,339.14 / $5,166.16
| Professional | | $662.93 | $1,339.14 | $5,166.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $844.05 / $1,097.27 / $1,936.25
| Facility | | $844.05 | $1,097.27 | $1,936.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,195.54 / $1,684.72 / $2,282.69
| Professional | | $1,195.54 | $1,684.72 | $2,282.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $819.54 / $1,290.05 / $2,681.94
| Professional | | $819.54 | $1,290.05 | $2,681.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $711.61 / $1,539.04 / $6,679.00
| Facility | | $711.61 | $1,539.04 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $969.49 / $1,219.58 / $1,683.49
| Professional | | $969.49 | $1,219.58 | $1,683.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $879.82 / $1,813.05 / $2,667.86
| Professional | | $879.82 | $1,813.05 | $2,667.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,822.81 / $3,822.81 / $4,115.38
| Facility | | $3,822.81 | $3,822.81 | $4,115.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,640.00 / $4,569.00 / $26,542.00
| Facility | | $1,640.00 | $4,569.00 | $26,542.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $926.38 / $1,638.39 / $6,318.48
| Professional | | $926.38 | $1,638.39 | $6,318.48 |
- 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
- $782.88 / $1,194.42 / $2,491.13
| Professional | | $782.88 | $1,194.42 | $2,491.13 |