- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $515.53 / $2,747.00 / $5,039.00
| Facility | | $515.53 | $2,747.00 | $5,039.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $345.30 / $492.96 / $828.85
| Professional | | $345.30 | $492.96 | $828.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $818.35 / $1,878.00 / $7,161.00
| Facility | | $818.35 | $1,878.00 | $7,161.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $404.20 / $868.25 / $3,771.44
| Professional | | $404.20 | $868.25 | $3,771.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $433.48 / $557.02 / $994.40
| Facility | | $433.48 | $557.02 | $994.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $564.82 / $794.74 / $1,141.22
| Professional | | $564.82 | $794.74 | $1,141.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $462.83 / $769.39 / $1,469.94
| Professional | | $462.83 | $769.39 | $1,469.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $368.18 / $790.40 / $6,679.00
| Facility | | $368.18 | $790.40 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $597.73 / $724.05 / $998.80
| Professional | | $597.73 | $724.05 | $998.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $477.39 / $999.25 / $1,477.64
| Professional | | $477.39 | $999.25 | $1,477.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $762.93 / $762.93 / $762.93
| Professional | | $762.93 | $762.93 | $762.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,106.00 / $2,078.00 / $26,542.00
| Facility | | $1,106.00 | $2,078.00 | $26,542.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $584.13 / $1,128.65 / $3,771.44
| Professional | | $584.13 | $1,128.65 | $3,771.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,106.00 / $2,408.00 / $5,683.00
| Facility | | $1,106.00 | $2,408.00 | $5,683.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $539.26 / $832.17 / $2,043.26
| Professional | | $539.26 | $832.17 | $2,043.26 |