- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $475.55 / $2,581.76 / $3,693.00
| Facility | | $475.55 | $2,581.76 | $3,693.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $380.66 / $564.04 / $1,322.31
| Professional | | $380.66 | $564.04 | $1,322.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,089.00 / $2,580.01 / $8,498.00
| Facility | | $1,089.00 | $2,580.01 | $8,498.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $488.38 / $984.46 / $3,663.20
| Professional | | $488.38 | $984.46 | $3,663.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $604.92 / $786.41 / $1,387.71
| Facility | | $604.92 | $786.41 | $1,387.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $771.89 / $1,109.08 / $1,603.75
| Professional | | $771.89 | $1,109.08 | $1,603.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $578.46 / $941.27 / $1,915.74
| Professional | | $578.46 | $941.27 | $1,915.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $508.23 / $1,103.02 / $6,679.00
| Facility | | $508.23 | $1,103.02 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $711.01 / $897.68 / $1,239.15
| Professional | | $711.01 | $897.68 | $1,239.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $629.15 / $1,306.61 / $1,968.89
| Professional | | $629.15 | $1,306.61 | $1,968.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,448.55 / $1,541.21 / $2,941.55
| Facility | | $1,448.55 | $1,541.21 | $2,941.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,640.00 / $3,372.00 / $16,394.00
| Facility | | $1,640.00 | $3,372.00 | $16,394.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $673.38 / $1,172.54 / $4,603.28
| Professional | | $673.38 | $1,172.54 | $4,603.28 |
- 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
- $526.67 / $870.71 / $1,799.83
| Professional | | $526.67 | $870.71 | $1,799.83 |