- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $524.89 / $2,747.00 / $5,039.00
| Facility | | $524.89 | $2,747.00 | $5,039.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $418.65 / $535.82 / $1,518.16
| Professional | | $418.65 | $535.82 | $1,518.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,468.03 / $4,983.00 / $15,220.00
| Facility | | $1,468.03 | $4,983.00 | $15,220.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $680.93 / $1,563.89 / $5,454.48
| Professional | | $680.93 | $1,563.89 | $5,454.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $733.94 / $954.12 / $1,683.66
| Facility | | $733.94 | $954.12 | $1,683.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,010.39 / $1,470.12 / $2,921.06
| Professional | | $1,010.39 | $1,470.12 | $2,921.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $300.00 / $1,003.70 / $8,090.00
| Facility | | $300.00 | $1,003.70 | $8,090.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $871.80 / $1,101.61 / $1,855.43
| Professional | | $871.80 | $1,101.61 | $1,855.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $788.46 / $1,633.92 / $2,358.83
| Professional | | $788.46 | $1,633.92 | $2,358.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,325.77 / $1,325.77 / $1,325.77
| Professional | | $1,325.77 | $1,325.77 | $1,325.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,155.00 / $5,572.00 / $26,542.00
| Facility | | $2,155.00 | $5,572.00 | $26,542.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $886.49 / $1,948.28 / $5,454.48
| Professional | | $886.49 | $1,948.28 | $5,454.48 |
- 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
- $840.76 / $1,132.50 / $2,244.76
| Professional | | $840.76 | $1,132.50 | $2,244.76 |