- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $682.16 / $2,747.00 / $5,039.00
| Facility | | $682.16 | $2,747.00 | $5,039.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $434.34 / $658.98 / $1,012.56
| Professional | | $434.34 | $658.98 | $1,012.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,061.00 / $2,854.00 / $9,039.00
| Facility | | $1,061.00 | $2,854.00 | $9,039.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $582.10 / $1,230.66 / $5,615.12
| Professional | | $582.10 | $1,230.66 | $5,615.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $627.65 / $806.53 / $1,439.83
| Facility | | $627.65 | $806.53 | $1,439.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $592.85 / $1,099.23 / $1,927.51
| Professional | | $592.85 | $1,099.23 | $1,927.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $527.00 / $1,144.46 / $6,679.00
| Facility | | $527.00 | $1,144.46 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $906.40 / $1,105.84 / $1,529.11
| Professional | | $906.40 | $1,105.84 | $1,529.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $686.41 / $1,442.76 / $2,258.76
| Professional | | $686.41 | $1,442.76 | $2,258.76 |
- 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
- $742.90 / $1,473.31 / $5,615.12
| Professional | | $742.90 | $1,473.31 | $5,615.12 |
- 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
- $731.55 / $1,203.95 / $2,489.27
| Professional | | $731.55 | $1,203.95 | $2,489.27 |