- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $726.71 / $2,663.12 / $3,625.00
| Facility | | $726.71 | $2,663.12 | $3,625.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $573.41 / $684.91 / $1,129.32
| Professional | | $573.41 | $684.91 | $1,129.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,011.74 / $2,411.51 / $8,498.00
| Facility | | $1,011.74 | $2,411.51 | $8,498.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $557.38 / $1,318.22 / $5,117.68
| Professional | | $557.38 | $1,318.22 | $5,117.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $721.98 / $927.74 / $1,656.22
| Facility | | $721.98 | $927.74 | $1,656.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $642.82 / $1,151.40 / $1,983.41
| Professional | | $642.82 | $1,151.40 | $1,983.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $597.51 / $1,316.46 / $6,679.00
| Facility | | $597.51 | $1,316.46 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $825.84 / $1,007.57 / $1,401.08
| Professional | | $825.84 | $1,007.57 | $1,401.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $740.89 / $1,526.75 / $2,003.01
| Professional | | $740.89 | $1,526.75 | $2,003.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,640.00 / $3,672.00 / $16,394.00
| Facility | | $1,640.00 | $3,672.00 | $16,394.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $642.11 / $1,481.23 / $5,117.68
| Professional | | $642.11 | $1,481.23 | $5,117.68 |
- 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
- $599.23 / $1,114.50 / $2,288.55
| Professional | | $599.23 | $1,114.50 | $2,288.55 |