- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $525.97 / $2,663.12 / $3,625.00
| Facility | | $525.97 | $2,663.12 | $3,625.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $482.02 / $584.47 / $902.87
| Professional | | $482.02 | $584.47 | $902.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,636.02 / $5,006.88 / $9,401.00
| Facility | | $1,636.02 | $5,006.88 | $9,401.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $620.97 / $1,210.55 / $5,264.88
| Professional | | $620.97 | $1,210.55 | $5,264.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $862.59 / $1,121.36 / $1,978.78
| Facility | | $862.59 | $1,121.36 | $1,978.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $784.24 / $1,191.83 / $2,755.28
| Professional | | $784.24 | $1,191.83 | $2,755.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $727.92 / $1,572.84 / $6,679.00
| Facility | | $727.92 | $1,572.84 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $877.54 / $1,097.97 / $1,515.62
| Professional | | $877.54 | $1,097.97 | $1,515.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $905.22 / $1,786.90 / $2,451.42
| Professional | | $905.22 | $1,786.90 | $2,451.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,155.00 / $5,006.88 / $16,394.00
| Facility | | $2,155.00 | $5,006.88 | $16,394.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $816.00 / $1,461.20 / $5,725.36
| Professional | | $816.00 | $1,461.20 | $5,725.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,155.00 / $4,983.00 / $8,810.00
| Facility | | $2,155.00 | $4,983.00 | $8,810.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $758.56 / $1,104.91 / $2,283.94
| Professional | | $758.56 | $1,104.91 | $2,283.94 |