- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $373.25 / $4,032.00 / $8,920.00
| Facility | | $373.25 | $4,032.00 | $8,920.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $373.25 / $885.44 / $1,142.95
| Professional | | $373.25 | $885.44 | $1,142.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $509.17 / $776.55 / $10,056.00
| Facility | | $509.17 | $776.55 | $10,056.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $423.18 / $541.16 / $894.69
| Professional | | $423.18 | $541.16 | $894.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $640.00 / $640.00 / $989.08
| Facility | | $640.00 | $640.00 | $989.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,832.91 / $2,832.91 / $2,832.91
| Professional | | $2,832.91 | $2,832.91 | $2,832.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $626.60 / $801.76 / $927.37
| Professional | | $626.60 | $801.76 | $927.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $373.25 / $663.17 / $1,283.89
| Facility | | $373.25 | $663.17 | $1,283.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,558.00 / $2,002.00 / $2,045.54
| Professional | | $1,558.00 | $2,002.00 | $2,045.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $504.60 / $986.06 / $2,184.00
| Facility | | $504.60 | $986.06 | $2,184.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $504.60 / $986.06 / $2,184.00
| Professional | | $504.60 | $986.06 | $2,184.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $231.00 / $1,045.00 / $2,364.00
| Facility | | $231.00 | $1,045.00 | $2,364.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $341.98 / $752.47 / $1,468.84
| Professional | | $341.98 | $752.47 | $1,468.84 |