- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,758.00 / $2,747.00 / $5,454.00
| Facility | | $1,758.00 | $2,747.00 | $5,454.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $393.84 / $475.24 / $1,197.38
| Professional | | $393.84 | $475.24 | $1,197.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $746.60 / $2,575.00 / $5,737.16
| Facility | | $746.60 | $2,575.00 | $5,737.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $456.09 / $786.54 / $3,319.84
| Professional | | $456.09 | $786.54 | $3,319.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $590.38 / $878.10 / $1,185.83
| Professional | | $590.38 | $878.10 | $1,185.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $462.44 / $786.40 / $1,302.88
| Professional | | $462.44 | $786.40 | $1,302.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $453.00 / $973.32 / $6,679.00
| Facility | | $453.00 | $973.32 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $519.82 / $629.66 / $856.52
| Professional | | $519.82 | $629.66 | $856.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $561.15 / $1,112.42 / $1,467.46
| Professional | | $561.15 | $1,112.42 | $1,467.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $473.60 / $473.60 / $8,157.26
| Facility | | $473.60 | $473.60 | $8,157.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $331.89 / $686.75 / $702.93
| Professional | | $331.89 | $686.75 | $702.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $2,854.00 / $9,039.00
| Facility | | $55.00 | $2,854.00 | $9,039.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $495.27 / $789.41 / $3,319.84
| Professional | | $495.27 | $789.41 | $3,319.84 |
- 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
- $490.52 / $709.06 / $1,318.98
| Professional | | $490.52 | $709.06 | $1,318.98 |