- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $791.34 / $2,079.00 / $3,685.00
| Facility | | $791.34 | $2,079.00 | $3,685.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $655.45 / $791.34 / $1,812.77
| Professional | | $655.45 | $791.34 | $1,812.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $818.35 / $2,411.51 / $4,851.47
| Facility | | $818.35 | $2,411.51 | $4,851.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $677.60 / $1,582.33 / $6,144.16
| Professional | | $677.60 | $1,582.33 | $6,144.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $860.95 / $1,106.32 / $1,975.02
| Facility | | $860.95 | $1,106.32 | $1,975.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $782.36 / $1,346.89 / $2,385.23
| Professional | | $782.36 | $1,346.89 | $2,385.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $713.91 / $1,569.86 / $6,679.00
| Facility | | $713.91 | $1,569.86 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $989.73 / $1,207.51 / $1,676.54
| Professional | | $989.73 | $1,207.51 | $1,676.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $888.85 / $1,831.67 / $2,394.55
| Professional | | $888.85 | $1,831.67 | $2,394.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $3,372.00 / $8,498.00
| Facility | | $55.00 | $3,372.00 | $8,498.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $766.22 / $1,716.32 / $6,144.16
| Professional | | $766.22 | $1,716.32 | $6,144.16 |
- 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
- $689.63 / $1,270.05 / $2,617.03
| Professional | | $689.63 | $1,270.05 | $2,617.03 |