- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $391.34 / $2,822.00 / $6,075.00
| Facility | | $391.34 | $2,822.00 | $6,075.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $292.08 / $433.62 / $927.58
| Professional | | $292.08 | $433.62 | $927.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $941.10 / $2,376.00 / $8,498.00
| Facility | | $941.10 | $2,376.00 | $8,498.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $418.77 / $803.76 / $2,937.28
| Professional | | $418.77 | $803.76 | $2,937.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $487.63 / $633.91 / $1,118.61
| Facility | | $487.63 | $633.91 | $1,118.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $455.67 / $726.06 / $1,566.62
| Professional | | $455.67 | $726.06 | $1,566.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $408.57 / $889.14 / $6,679.00
| Facility | | $408.57 | $889.14 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $606.58 / $768.52 / $1,061.16
| Professional | | $606.58 | $768.52 | $1,061.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $504.63 / $1,058.71 / $1,640.05
| Professional | | $504.63 | $1,058.71 | $1,640.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,640.00 / $3,372.00 / $26,542.00
| Facility | | $1,640.00 | $3,372.00 | $26,542.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $538.74 / $988.82 / $3,913.12
| Professional | | $538.74 | $988.82 | $3,913.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,640.00 / $3,592.00 / $8,425.00
| Facility | | $1,640.00 | $3,592.00 | $8,425.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $462.50 / $709.87 / $1,467.36
| Professional | | $462.50 | $709.87 | $1,467.36 |