- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $824.18 / $2,663.12 / $3,625.00
| Facility | | $824.18 | $2,663.12 | $3,625.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $710.10 / $868.53 / $1,350.14
| Professional | | $710.10 | $868.53 | $1,350.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,089.00 / $2,826.85 / $8,498.00
| Facility | | $1,089.00 | $2,826.85 | $8,498.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $784.46 / $1,671.98 / $6,545.68
| Professional | | $784.46 | $1,671.98 | $6,545.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $937.74 / $1,205.00 / $2,151.17
| Facility | | $937.74 | $1,205.00 | $2,151.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $856.37 / $1,416.22 / $2,534.83
| Professional | | $856.37 | $1,416.22 | $2,534.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $788.62 / $1,709.86 / $6,679.00
| Facility | | $788.62 | $1,709.86 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,052.23 / $1,274.67 / $1,759.54
| Professional | | $1,052.23 | $1,274.67 | $1,759.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $983.86 / $2,027.44 / $2,661.86
| Professional | | $983.86 | $2,027.44 | $2,661.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,813.08 / $2,813.08 / $2,813.08
| Professional | | $2,813.08 | $2,813.08 | $2,813.08 |
- 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
- $928.66 / $1,885.78 / $6,545.68
| Professional | | $928.66 | $1,885.78 | $6,545.68 |
- 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
- $784.46 / $1,266.65 / $2,685.22
| Professional | | $784.46 | $1,266.65 | $2,685.22 |