- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $532.04 / $2,663.12 / $4,410.00
| Facility | | $532.04 | $2,663.12 | $4,410.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $324.04 / $517.29 / $931.17
| Professional | | $324.04 | $517.29 | $931.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $857.41 / $2,854.00 / $9,039.00
| Facility | | $857.41 | $2,854.00 | $9,039.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $416.22 / $896.73 / $3,976.72
| Professional | | $416.22 | $896.73 | $3,976.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $438.56 / $563.54 / $1,006.06
| Facility | | $438.56 | $563.54 | $1,006.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $599.95 / $846.28 / $1,442.99
| Professional | | $599.95 | $846.28 | $1,442.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $464.59 / $767.70 / $1,450.20
| Professional | | $464.59 | $767.70 | $1,450.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $371.31 / $799.68 / $6,679.00
| Facility | | $371.31 | $799.68 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $634.41 / $770.94 / $1,064.20
| Professional | | $634.41 | $770.94 | $1,064.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $482.12 / $1,013.37 / $1,568.53
| Professional | | $482.12 | $1,013.37 | $1,568.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,876.87 / $3,764.00 / $26,542.00
| Facility | | $1,876.87 | $3,764.00 | $26,542.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $591.57 / $1,145.55 / $3,976.72
| Professional | | $591.57 | $1,145.55 | $3,976.72 |
- 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
- $544.55 / $839.08 / $1,641.83
| Professional | | $544.55 | $839.08 | $1,641.83 |