- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $630.87 / $2,663.12 / $4,712.00
| Facility | | $630.87 | $2,663.12 | $4,712.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $505.71 / $738.20 / $1,395.50
| Professional | | $505.71 | $738.20 | $1,395.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,313.00 / $3,402.71 / $9,151.39
| Facility | | $1,313.00 | $3,402.71 | $9,151.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $640.84 / $1,287.15 / $4,868.39
| Professional | | $640.84 | $1,287.15 | $4,868.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $798.21 / $1,037.67 / $1,831.09
| Facility | | $798.21 | $1,037.67 | $1,831.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,008.43 / $1,451.13 / $2,094.21
| Professional | | $1,008.43 | $1,451.13 | $2,094.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $747.77 / $1,227.49 / $2,539.00
| Professional | | $747.77 | $1,227.49 | $2,539.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $672.87 / $1,455.46 / $6,679.00
| Facility | | $672.87 | $1,455.46 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $931.24 / $1,172.22 / $1,618.13
| Professional | | $931.24 | $1,172.22 | $1,618.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $834.76 / $1,726.43 / $2,554.37
| Professional | | $834.76 | $1,726.43 | $2,554.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,704.71 / $4,527.85 / $9,984.53
| Facility | | $1,704.71 | $4,527.85 | $9,984.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,902.00 / $3,764.00 / $26,542.00
| Facility | | $1,902.00 | $3,764.00 | $26,542.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $881.56 / $1,568.12 / $6,049.44
| Professional | | $881.56 | $1,568.12 | $6,049.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,902.00 / $3,764.00 / $8,766.00
| Facility | | $1,902.00 | $3,764.00 | $8,766.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $687.60 / $1,159.54 / $2,268.07
| Professional | | $687.60 | $1,159.54 | $2,268.07 |