- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $653.35 / $2,703.00 / $7,101.31
| Facility | | $653.35 | $2,703.00 | $7,101.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $491.50 / $815.15 / $2,610.00
| Professional | | $491.50 | $815.15 | $2,610.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,313.00 / $3,997.00 / $12,379.00
| Facility | | $1,313.00 | $3,997.00 | $12,379.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $594.92 / $1,267.42 / $5,932.42
| Professional | | $594.92 | $1,267.42 | $5,932.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,030.39 / $1,351.96 / $1,942.69
| Professional | | $1,030.39 | $1,351.96 | $1,942.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $876.72 / $1,464.85 / $2,658.30
| Professional | | $876.72 | $1,464.85 | $2,658.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $674.88 / $1,474.72 / $6,679.00
| Facility | | $674.88 | $1,474.72 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $774.42 / $978.58 / $1,513.14
| Professional | | $774.42 | $978.58 | $1,513.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $827.80 / $1,650.96 / $2,200.29
| Professional | | $827.80 | $1,650.96 | $2,200.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $311.01 / $3,731.28 / $8,193.44
| Facility | | $311.01 | $3,731.28 | $8,193.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,201.07 / $2,044.91 / $2,147.15
| Professional | | $1,201.07 | $2,044.91 | $2,147.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,902.00 / $4,525.00 / $26,542.00
| Facility | | $1,902.00 | $4,525.00 | $26,542.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $641.88 / $1,422.39 / $5,932.42
| Professional | | $641.88 | $1,422.39 | $5,932.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,700.00 / $4,249.00 / $9,821.00
| Facility | | $1,700.00 | $4,249.00 | $9,821.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $641.65 / $997.59 / $2,294.59
| Professional | | $641.65 | $997.59 | $2,294.59 |