- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,147.98 / $2,663.12 / $3,625.00
| Facility | | $1,147.98 | $2,663.12 | $3,625.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $345.90 / $601.05 / $1,147.98
| Professional | | $345.90 | $601.05 | $1,147.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $850.03 / $4,751.20 / $13,773.00
| Facility | | $850.03 | $4,751.20 | $13,773.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $418.11 / $981.26 / $4,505.20
| Professional | | $418.11 | $981.26 | $4,505.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $435.56 / $559.69 / $999.17
| Facility | | $435.56 | $559.69 | $999.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $460.70 / $866.88 / $1,735.20
| Professional | | $460.70 | $866.88 | $1,735.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $366.33 / $794.20 / $6,679.00
| Facility | | $366.33 | $794.20 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $724.38 / $883.78 / $1,224.98
| Professional | | $724.38 | $883.78 | $1,224.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $472.66 / $993.84 / $1,774.74
| Professional | | $472.66 | $993.84 | $1,774.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,324.00 / $5,063.00 / $16,394.00
| Facility | | $2,324.00 | $5,063.00 | $16,394.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $683.54 / $1,392.02 / $4,505.20
| Professional | | $683.54 | $1,392.02 | $4,505.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,324.00 / $5,097.00 / $10,764.00
| Facility | | $2,324.00 | $5,097.00 | $10,764.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $620.22 / $1,020.44 / $1,901.68
| Professional | | $620.22 | $1,020.44 | $1,901.68 |