- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $775.62 / $2,618.00 / $3,625.00
| Facility | | $775.62 | $2,618.00 | $3,625.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $645.22 / $936.80 / $2,227.44
| Professional | | $645.22 | $936.80 | $2,227.44 |
- 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
- $771.47 / $1,550.93 / $6,115.44
| Professional | | $771.47 | $1,550.93 | $6,115.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $998.81 / $1,298.45 / $2,291.27
| Facility | | $998.81 | $1,298.45 | $2,291.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $942.48 / $1,525.90 / $3,180.06
| Professional | | $942.48 | $1,525.90 | $3,180.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $843.01 / $1,811.48 / $6,679.00
| Facility | | $843.01 | $1,811.48 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,128.74 / $1,417.74 / $1,957.03
| Professional | | $1,128.74 | $1,417.74 | $1,957.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,045.30 / $2,149.87 / $2,963.13
| Professional | | $1,045.30 | $2,149.87 | $2,963.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,050.05 / $3,050.05 / $3,050.05
| Facility | | $3,050.05 | $3,050.05 | $3,050.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,640.00 / $4,261.32 / $16,394.00
| Facility | | $1,640.00 | $4,261.32 | $16,394.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $987.54 / $1,910.41 / $7,356.16
| Professional | | $987.54 | $1,910.41 | $7,356.16 |
- 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
- $865.43 / $1,423.01 / $2,777.05
| Professional | | $865.43 | $1,423.01 | $2,777.05 |