- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,486.00 / $2,663.12 / $4,767.00
| Facility | | $1,486.00 | $2,663.12 | $4,767.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $599.87 / $739.55 / $2,028.60
| Professional | | $599.87 | $739.55 | $2,028.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $818.35 / $2,376.00 / $5,737.16
| Facility | | $818.35 | $2,376.00 | $5,737.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $686.91 / $1,100.23 / $4,781.04
| Professional | | $686.91 | $1,100.23 | $4,781.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $830.51 / $1,287.64 / $1,738.90
| Professional | | $830.51 | $1,287.64 | $1,738.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $712.45 / $1,154.65 / $1,909.02
| Professional | | $712.45 | $1,154.65 | $1,909.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $662.48 / $1,427.28 / $6,679.00
| Facility | | $662.48 | $1,427.28 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $760.20 / $920.85 / $1,256.01
| Professional | | $760.20 | $920.85 | $1,256.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $830.26 / $1,645.91 / $2,171.21
| Professional | | $830.26 | $1,645.91 | $2,171.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,085.25 / $4,085.25 / $6,079.20
| Facility | | $4,085.25 | $4,085.25 | $6,079.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $512.69 / $1,328.00 / $1,367.79
| Professional | | $512.69 | $1,328.00 | $1,367.79 |
- 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
- $727.46 / $1,187.19 / $4,781.04
| Professional | | $727.46 | $1,187.19 | $4,781.04 |
- 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
- $700.43 / $1,044.48 / $2,141.40
| Professional | | $700.43 | $1,044.48 | $2,141.40 |