- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $500.26 / $2,663.12 / $4,410.00
| Facility | | $500.26 | $2,663.12 | $4,410.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $325.74 / $485.64 / $813.68
| Professional | | $325.74 | $485.64 | $813.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $818.31 / $5,097.00 / $15,421.00
| Facility | | $818.31 | $5,097.00 | $15,421.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $385.33 / $857.91 / $3,959.35
| Professional | | $385.33 | $857.91 | $3,959.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $412.65 / $530.26 / $946.62
| Facility | | $412.65 | $530.26 | $946.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $454.97 / $749.34 / $1,411.16
| Professional | | $454.97 | $749.34 | $1,411.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $350.83 / $752.42 / $6,679.00
| Facility | | $350.83 | $752.42 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $584.91 / $708.52 / $977.64
| Professional | | $584.91 | $708.52 | $977.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $455.03 / $952.44 / $1,452.05
| Professional | | $455.03 | $952.44 | $1,452.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,769.95 / $5,904.00 / $26,542.00
| Facility | | $1,769.95 | $5,904.00 | $26,542.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $589.58 / $1,110.96 / $3,959.35
| Professional | | $589.58 | $1,110.96 | $3,959.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,386.00 / $5,904.00 / $13,017.00
| Facility | | $2,386.00 | $5,904.00 | $13,017.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $559.30 / $932.46 / $1,706.25
| Professional | | $559.30 | $932.46 | $1,706.25 |