- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $557.10 / $2,747.00 / $5,039.00
| Facility | | $557.10 | $2,747.00 | $5,039.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $384.01 / $551.98 / $870.84
| Professional | | $384.01 | $551.98 | $870.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $941.10 / $2,854.00 / $9,039.00
| Facility | | $941.10 | $2,854.00 | $9,039.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $448.35 / $953.44 / $4,134.56
| Professional | | $448.35 | $953.44 | $4,134.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $481.70 / $618.98 / $1,105.02
| Facility | | $481.70 | $618.98 | $1,105.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $516.71 / $855.08 / $1,595.42
| Professional | | $516.71 | $855.08 | $1,595.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $410.93 / $878.32 / $6,679.00
| Facility | | $410.93 | $878.32 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $651.91 / $789.67 / $1,085.04
| Professional | | $651.91 | $789.67 | $1,085.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $521.92 / $1,112.06 / $1,624.87
| Professional | | $521.92 | $1,112.06 | $1,624.87 |
- 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
- $652.19 / $1,233.00 / $4,134.56
| Professional | | $652.19 | $1,233.00 | $4,134.56 |
- 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
- $619.71 / $936.40 / $1,684.42
| Professional | | $619.71 | $936.40 | $1,684.42 |