- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $576.71 / $2,663.12 / $4,410.00
| Facility | | $576.71 | $2,663.12 | $4,410.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $402.19 / $557.58 / $927.91
| Professional | | $402.19 | $557.58 | $927.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $962.27 / $2,854.00 / $9,039.00
| Facility | | $962.27 | $2,854.00 | $9,039.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $467.68 / $986.35 / $4,247.43
| Professional | | $467.68 | $986.35 | $4,247.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $515.87 / $662.89 / $1,183.41
| Facility | | $515.87 | $662.89 | $1,183.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $672.18 / $925.88 / $1,294.61
| Professional | | $672.18 | $925.88 | $1,294.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $506.53 / $879.26 / $1,655.56
| Professional | | $506.53 | $879.26 | $1,655.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $435.40 / $940.62 / $6,679.00
| Facility | | $435.40 | $940.62 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $676.06 / $820.81 / $1,133.04
| Professional | | $676.06 | $820.81 | $1,133.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $549.57 / $1,168.84 / $1,676.42
| Professional | | $549.57 | $1,168.84 | $1,676.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $892.36 / $892.36 / $953.78
| Professional | | $892.36 | $892.36 | $953.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,902.00 / $3,764.00 / $26,542.00
| Facility | | $1,902.00 | $3,764.00 | $26,542.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $579.88 / $1,232.25 / $4,247.43
| Professional | | $579.88 | $1,232.25 | $4,247.43 |
- 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
- $578.50 / $902.92 / $1,691.24
| Professional | | $578.50 | $902.92 | $1,691.24 |