- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $875.62 / $1,845.24 / $3,625.00
| Facility | | $875.62 | $1,845.24 | $3,625.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $465.67 / $697.55 / $1,460.28
| Professional | | $465.67 | $697.55 | $1,460.28 |
- 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
- $590.55 / $1,186.10 / $4,435.20
| Professional | | $590.55 | $1,186.10 | $4,435.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $726.70 / $944.71 / $1,667.05
| Facility | | $726.70 | $944.71 | $1,667.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $929.28 / $1,304.34 / $1,929.84
| Professional | | $929.28 | $1,304.34 | $1,929.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $687.32 / $1,157.50 / $2,314.19
| Professional | | $687.32 | $1,157.50 | $2,314.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $611.83 / $1,325.06 / $6,679.00
| Facility | | $611.83 | $1,325.06 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $856.96 / $1,080.21 / $1,491.11
| Professional | | $856.96 | $1,080.21 | $1,491.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $755.71 / $1,569.46 / $2,368.78
| Professional | | $755.71 | $1,569.46 | $2,368.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,103.34 / $3,103.34 / $3,103.34
| Facility | | $3,103.34 | $3,103.34 | $3,103.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,640.00 / $4,200.78 / $16,394.00
| Facility | | $1,640.00 | $4,200.78 | $16,394.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $838.37 / $1,453.06 / $5,573.28
| Professional | | $838.37 | $1,453.06 | $5,573.28 |
- 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
- $688.42 / $1,126.14 / $2,211.09
| Professional | | $688.42 | $1,126.14 | $2,211.09 |