- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.07 / $2,663.12 / $3,625.00
| Facility | | $575.07 | $2,663.12 | $3,625.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $332.97 / $575.07 / $873.32
| Professional | | $332.97 | $575.07 | $873.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $941.10 / $3,100.20 / $10,821.00
| Facility | | $941.10 | $3,100.20 | $10,821.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $532.66 / $1,181.91 / $5,506.44
| Professional | | $532.66 | $1,181.91 | $5,506.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $559.25 / $718.64 / $1,282.92
| Facility | | $559.25 | $718.64 | $1,282.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $501.11 / $1,047.17 / $1,905.81
| Professional | | $501.11 | $1,047.17 | $1,905.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $459.21 / $1,019.74 / $6,679.00
| Facility | | $459.21 | $1,019.74 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $838.46 / $1,022.95 / $1,436.39
| Professional | | $838.46 | $1,022.95 | $1,436.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $582.33 / $1,228.44 / $2,096.46
| Professional | | $582.33 | $1,228.44 | $2,096.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,640.00 / $3,372.00 / $16,394.00
| Facility | | $1,640.00 | $3,372.00 | $16,394.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $712.34 / $1,493.00 / $5,506.44
| Professional | | $712.34 | $1,493.00 | $5,506.44 |
- 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
- $673.05 / $1,178.02 / $2,247.38
| Professional | | $673.05 | $1,178.02 | $2,247.38 |