- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $504.54 / $2,410.00 / $3,625.00
| Facility | | $504.54 | $2,410.00 | $3,625.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $362.54 / $483.77 / $793.63
| Professional | | $362.54 | $483.77 | $793.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $871.32 / $2,854.00 / $9,039.00
| Facility | | $871.32 | $2,854.00 | $9,039.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $396.86 / $825.52 / $3,387.60
| Professional | | $396.86 | $825.52 | $3,387.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $437.33 / $561.97 / $1,003.24
| Facility | | $437.33 | $561.97 | $1,003.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $450.99 / $745.13 / $1,370.04
| Professional | | $450.99 | $745.13 | $1,370.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $368.30 / $797.42 / $6,679.00
| Facility | | $368.30 | $797.42 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $539.20 / $654.48 / $903.44
| Professional | | $539.20 | $654.48 | $903.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $464.35 / $980.26 / $1,338.03
| Professional | | $464.35 | $980.26 | $1,338.03 |
- 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
- $511.75 / $1,026.64 / $3,387.60
| Professional | | $511.75 | $1,026.64 | $3,387.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,700.00 / $4,249.00 / $9,821.00
| Facility | | $1,700.00 | $4,249.00 | $9,821.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $453.16 / $754.66 / $1,430.25
| Professional | | $453.16 | $754.66 | $1,430.25 |