- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $767.95 / $3,107.00 / $8,271.00
| Facility | | $767.95 | $3,107.00 | $8,271.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $569.25 / $702.51 / $1,221.16
| Professional | | $569.25 | $702.51 | $1,221.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,061.00 / $3,698.94 / $9,039.00
| Facility | | $1,061.00 | $3,698.94 | $9,039.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $585.67 / $1,205.64 / $5,790.42
| Professional | | $585.67 | $1,205.64 | $5,790.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $635.82 / $817.03 / $1,458.57
| Facility | | $635.82 | $817.03 | $1,458.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,042.61 / $1,256.41 / $1,578.11
| Professional | | $1,042.61 | $1,256.41 | $1,578.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $652.78 / $1,083.08 / $1,853.19
| Professional | | $652.78 | $1,083.08 | $1,853.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $537.49 / $1,159.33 / $7,315.92
| Facility | | $537.49 | $1,159.33 | $7,315.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $737.67 / $893.56 / $1,229.43
| Professional | | $737.67 | $893.56 | $1,229.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $669.86 / $1,389.55 / $1,836.20
| Professional | | $669.86 | $1,389.55 | $1,836.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $997.38 / $997.38 / $997.38
| Facility | | $997.38 | $997.38 | $997.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,902.00 / $3,764.00 / $26,542.00
| Facility | | $1,902.00 | $3,764.00 | $26,542.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $787.78 / $1,397.08 / $5,790.42
| Professional | | $787.78 | $1,397.08 | $5,790.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,902.00 / $3,764.00 / $8,766.00
| Facility | | $1,902.00 | $3,764.00 | $8,766.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $719.37 / $1,061.89 / $2,163.06
| Professional | | $719.37 | $1,061.89 | $2,163.06 |