- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $480.71 / $2,671.00 / $4,410.00
| Facility | | $480.71 | $2,671.00 | $4,410.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.83 / $480.71 / $756.54
| Professional | | $354.83 | $480.71 | $756.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $941.10 / $2,854.00 / $11,217.00
| Facility | | $941.10 | $2,854.00 | $11,217.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $422.58 / $925.33 / $3,941.84
| Professional | | $422.58 | $925.33 | $3,941.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $485.50 / $623.87 / $1,113.74
| Facility | | $485.50 | $623.87 | $1,113.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $453.31 / $796.21 / $1,452.30
| Professional | | $453.31 | $796.21 | $1,452.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $407.03 / $885.26 / $6,679.00
| Facility | | $407.03 | $885.26 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $634.44 / $774.05 / $1,068.64
| Professional | | $634.44 | $774.05 | $1,068.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $515.55 / $1,096.52 / $1,574.27
| Professional | | $515.55 | $1,096.52 | $1,574.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,902.00 / $3,764.00 / $26,542.00
| Facility | | $1,902.00 | $3,764.00 | $26,542.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $522.60 / $1,141.86 / $3,941.84
| Professional | | $522.60 | $1,141.86 | $3,941.84 |
- 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
- $513.91 / $897.19 / $1,651.10
| Professional | | $513.91 | $897.19 | $1,651.10 |