- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $623.17 / $2,663.12 / $4,712.00
| Facility | | $623.17 | $2,663.12 | $4,712.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $455.46 / $628.71 / $1,373.84
| Professional | | $455.46 | $628.71 | $1,373.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,061.00 / $2,943.10 / $9,039.00
| Facility | | $1,061.00 | $2,943.10 | $9,039.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $567.59 / $1,161.69 / $5,079.67
| Professional | | $567.59 | $1,161.69 | $5,079.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $610.71 / $784.76 / $1,400.97
| Facility | | $610.71 | $784.76 | $1,400.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $828.73 / $1,149.36 / $1,689.83
| Professional | | $828.73 | $1,149.36 | $1,689.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $629.67 / $1,029.83 / $1,908.09
| Professional | | $629.67 | $1,029.83 | $1,908.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $514.16 / $1,113.56 / $6,679.00
| Facility | | $514.16 | $1,113.56 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $778.25 / $945.86 / $1,305.66
| Professional | | $778.25 | $945.86 | $1,305.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $655.80 / $1,390.41 / $1,949.45
| Professional | | $655.80 | $1,390.41 | $1,949.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,009.45 / $4,009.45 / $4,009.45
| Professional | | $4,009.45 | $4,009.45 | $4,009.45 |
- 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
- $762.22 / $1,439.24 / $5,079.67
| Professional | | $762.22 | $1,439.24 | $5,079.67 |
- 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
- $698.78 / $1,021.53 / $2,024.68
| Professional | | $698.78 | $1,021.53 | $2,024.68 |