- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $650.69 / $2,663.12 / $3,625.00
| Facility | | $650.69 | $2,663.12 | $3,625.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $536.58 / $771.66 / $1,477.78
| Professional | | $536.58 | $771.66 | $1,477.78 |
- 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
- $647.47 / $1,301.93 / $5,083.04
| Professional | | $647.47 | $1,301.93 | $5,083.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $827.99 / $1,076.39 / $1,899.41
| Facility | | $827.99 | $1,076.39 | $1,899.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $781.30 / $1,274.23 / $2,651.10
| Professional | | $781.30 | $1,274.23 | $2,651.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $699.05 / $1,509.76 / $6,679.00
| Facility | | $699.05 | $1,509.76 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $940.08 / $1,180.66 / $1,629.78
| Professional | | $940.08 | $1,180.66 | $1,629.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $865.08 / $1,781.54 / $2,605.46
| Professional | | $865.08 | $1,781.54 | $2,605.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,941.55 / $2,941.55 / $2,941.55
| Facility | | $2,941.55 | $2,941.55 | $2,941.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,640.00 / $4,569.00 / $16,394.00
| Facility | | $1,640.00 | $4,569.00 | $16,394.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $907.12 / $1,600.34 / $6,137.60
| Professional | | $907.12 | $1,600.34 | $6,137.60 |
- 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
- $733.71 / $1,234.41 / $2,633.08
| Professional | | $733.71 | $1,234.41 | $2,633.08 |