- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $463.27 / $2,663.12 / $4,410.00
| Facility | | $463.27 | $2,663.12 | $4,410.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $326.29 / $442.61 / $677.48
| Professional | | $326.29 | $442.61 | $677.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $790.96 / $4,751.20 / $12,850.00
| Facility | | $790.96 | $4,751.20 | $12,850.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $353.97 / $752.86 / $3,246.64
| Professional | | $353.97 | $752.86 | $3,246.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $393.02 / $505.03 / $901.59
| Facility | | $393.02 | $505.03 | $901.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $395.87 / $670.72 / $1,232.27
| Professional | | $395.87 | $670.72 | $1,232.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $331.12 / $716.62 / $6,679.00
| Facility | | $331.12 | $716.62 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $519.37 / $631.61 / $871.87
| Professional | | $519.37 | $631.61 | $871.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $419.42 / $892.03 / $1,297.40
| Professional | | $419.42 | $892.03 | $1,297.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,274.48 / $5,063.00 / $26,542.00
| Facility | | $2,274.48 | $5,063.00 | $26,542.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $464.58 / $946.65 / $3,246.64
| Professional | | $464.58 | $946.65 | $3,246.64 |
- 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
- $442.46 / $693.53 / $1,380.27
| Professional | | $442.46 | $693.53 | $1,380.27 |