- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $477.66 / $2,663.12 / $4,410.00
| Facility | | $477.66 | $2,663.12 | $4,410.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $288.48 / $477.66 / $735.94
| Professional | | $288.48 | $477.66 | $735.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $794.65 / $2,376.00 / $8,498.00
| Facility | | $794.65 | $2,376.00 | $8,498.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $374.90 / $822.32 / $3,668.00
| Professional | | $374.90 | $822.32 | $3,668.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $403.19 / $518.10 / $924.92
| Facility | | $403.19 | $518.10 | $924.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $412.56 / $716.30 / $1,324.72
| Professional | | $412.56 | $716.30 | $1,324.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $337.02 / $735.18 / $6,679.00
| Facility | | $337.02 | $735.18 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $593.10 / $723.60 / $1,004.04
| Professional | | $593.10 | $723.60 | $1,004.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $436.10 / $916.97 / $1,447.65
| Professional | | $436.10 | $916.97 | $1,447.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,640.00 / $3,372.00 / $26,542.00
| Facility | | $1,640.00 | $3,372.00 | $26,542.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $528.64 / $1,071.53 / $3,668.00
| Professional | | $528.64 | $1,071.53 | $3,668.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,640.00 / $3,372.00 / $8,425.00
| Facility | | $1,640.00 | $3,372.00 | $8,425.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $477.43 / $753.32 / $1,719.47
| Professional | | $477.43 | $753.32 | $1,719.47 |