- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $475.55 / $2,410.00 / $3,625.00
| Facility | | $475.55 | $2,410.00 | $3,625.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $436.31 / $581.72 / $938.25
| Professional | | $436.31 | $581.72 | $938.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $969.29 / $3,041.58 / $11,217.00
| Facility | | $969.29 | $3,041.58 | $11,217.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $472.60 / $980.45 / $4,991.29
| Professional | | $472.60 | $980.45 | $4,991.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $527.36 / $677.66 / $1,209.76
| Facility | | $527.36 | $677.66 | $1,209.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $864.76 / $1,091.80 / $1,308.91
| Professional | | $864.76 | $1,091.80 | $1,308.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $539.00 / $875.55 / $1,568.71
| Professional | | $539.00 | $875.55 | $1,568.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $443.45 / $961.58 / $6,679.00
| Facility | | $443.45 | $961.58 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $637.25 / $773.94 / $1,068.33
| Professional | | $637.25 | $773.94 | $1,068.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $558.80 / $1,158.56 / $1,581.39
| Professional | | $558.80 | $1,158.56 | $1,581.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,103.34 / $3,103.34 / $3,103.34
| Facility | | $3,103.34 | $3,103.34 | $3,103.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,902.00 / $3,764.00 / $16,394.00
| Facility | | $1,902.00 | $3,764.00 | $16,394.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $603.04 / $1,211.10 / $4,991.29
| Professional | | $603.04 | $1,211.10 | $4,991.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,902.00 / $3,764.00 / $8,766.00
| Facility | | $1,902.00 | $3,764.00 | $8,766.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $557.29 / $868.53 / $1,722.57
| Professional | | $557.29 | $868.53 | $1,722.57 |