- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $514.34 / $2,663.12 / $3,625.00
| Facility | | $514.34 | $2,663.12 | $3,625.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $465.73 / $561.72 / $865.95
| Professional | | $465.73 | $561.72 | $865.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,089.00 / $3,149.11 / $9,151.39
| Facility | | $1,089.00 | $3,149.11 | $9,151.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $537.89 / $1,062.32 / $4,540.72
| Professional | | $537.89 | $1,062.32 | $4,540.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $745.29 / $968.88 / $1,709.70
| Facility | | $745.29 | $968.88 | $1,709.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $702.79 / $1,052.29 / $2,380.62
| Professional | | $702.79 | $1,052.29 | $2,380.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $630.91 / $1,358.96 / $6,679.00
| Facility | | $630.91 | $1,358.96 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $768.84 / $959.64 / $1,324.68
| Professional | | $768.84 | $959.64 | $1,324.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $793.40 / $1,566.17 / $2,168.84
| Professional | | $793.40 | $1,566.17 | $2,168.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,640.00 / $3,372.00 / $16,394.00
| Facility | | $1,640.00 | $3,372.00 | $16,394.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $771.53 / $1,286.61 / $4,991.60
| Professional | | $771.53 | $1,286.61 | $4,991.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,450.00 / $3,592.00 / $8,498.00
| Facility | | $1,450.00 | $3,592.00 | $8,498.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $659.14 / $962.46 / $2,048.87
| Professional | | $659.14 | $962.46 | $2,048.87 |