- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $505.75 / $2,663.12 / $4,410.00
| Facility | | $505.75 | $2,663.12 | $4,410.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $303.33 / $491.85 / $842.09
| Professional | | $303.33 | $491.85 | $842.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $807.61 / $2,854.00 / $9,039.00
| Facility | | $807.61 | $2,854.00 | $9,039.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $406.49 / $861.91 / $4,027.20
| Professional | | $406.49 | $861.91 | $4,027.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $429.07 / $551.35 / $984.29
| Facility | | $429.07 | $551.35 | $984.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $588.67 / $868.29 / $1,358.24
| Professional | | $588.67 | $868.29 | $1,358.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $427.47 / $729.61 / $1,338.14
| Professional | | $427.47 | $729.61 | $1,338.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $360.98 / $782.36 / $6,679.00
| Facility | | $360.98 | $782.36 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $647.36 / $789.81 / $1,091.89
| Professional | | $647.36 | $789.81 | $1,091.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $467.92 / $983.88 / $1,581.32
| Professional | | $467.92 | $983.88 | $1,581.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $775.61 / $775.61 / $775.61
| Professional | | $775.61 | $775.61 | $775.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,834.55 / $3,764.00 / $26,542.00
| Facility | | $1,834.55 | $3,764.00 | $26,542.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $532.64 / $1,076.92 / $4,027.20
| Professional | | $532.64 | $1,076.92 | $4,027.20 |
- 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
- $522.94 / $800.42 / $1,647.80
| Professional | | $522.94 | $800.42 | $1,647.80 |