- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $442.06 / $2,663.12 / $4,410.00
| Facility | | $442.06 | $2,663.12 | $4,410.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $393.16 / $458.73 / $738.73
| Professional | | $393.16 | $458.73 | $738.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,089.00 / $3,315.28 / $8,498.00
| Facility | | $1,089.00 | $3,315.28 | $8,498.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $506.02 / $1,052.08 / $4,093.62
| Professional | | $506.02 | $1,052.08 | $4,093.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $615.86 / $800.62 / $1,412.78
| Facility | | $615.86 | $800.62 | $1,412.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $559.05 / $878.37 / $1,978.79
| Professional | | $559.05 | $878.37 | $1,978.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $516.69 / $1,122.96 / $6,679.00
| Facility | | $516.69 | $1,122.96 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $642.61 / $809.19 / $1,117.00
| Professional | | $642.61 | $809.19 | $1,117.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $632.41 / $1,264.72 / $1,767.93
| Professional | | $632.41 | $1,264.72 | $1,767.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,640.00 / $3,538.02 / $26,542.00
| Facility | | $1,640.00 | $3,538.02 | $26,542.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $596.03 / $1,052.18 / $4,204.72
| Professional | | $596.03 | $1,052.18 | $4,204.72 |
- 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
- $474.74 / $791.53 / $1,575.11
| Professional | | $474.74 | $791.53 | $1,575.11 |