- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $570.94 / $2,663.12 / $4,410.00
| Facility | | $570.94 | $2,663.12 | $4,410.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $458.65 / $570.94 / $883.35
| Professional | | $458.65 | $570.94 | $883.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,061.00 / $2,854.00 / $5,714.00
| Facility | | $1,061.00 | $2,854.00 | $5,714.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $535.33 / $1,245.81 / $5,380.24
| Professional | | $535.33 | $1,245.81 | $5,380.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $740.38 / $951.39 / $1,698.43
| Facility | | $740.38 | $951.39 | $1,698.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $591.54 / $1,116.83 / $1,910.73
| Professional | | $591.54 | $1,116.83 | $1,910.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $608.74 / $1,350.00 / $6,679.00
| Facility | | $608.74 | $1,350.00 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $874.18 / $1,066.53 / $1,491.93
| Professional | | $874.18 | $1,066.53 | $1,491.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $754.45 / $1,568.27 / $2,178.57
| Professional | | $754.45 | $1,568.27 | $2,178.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,902.00 / $3,764.00 / $9,039.00
| Facility | | $1,902.00 | $3,764.00 | $9,039.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $537.71 / $1,435.93 / $5,380.24
| Professional | | $537.71 | $1,435.93 | $5,380.24 |
- 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
- $478.51 / $1,012.76 / $2,042.24
| Professional | | $478.51 | $1,012.76 | $2,042.24 |