- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $568.79 / $2,663.12 / $3,625.00
| Facility | | $568.79 | $2,663.12 | $3,625.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $307.12 / $472.49 / $859.01
| Professional | | $307.12 | $472.49 | $859.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $862.37 / $2,826.85 / $9,039.00
| Facility | | $862.37 | $2,826.85 | $9,039.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $408.81 / $938.91 / $4,213.76
| Professional | | $408.81 | $938.91 | $4,213.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $440.83 / $566.47 / $1,011.26
| Facility | | $440.83 | $566.47 | $1,011.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $428.41 / $788.89 / $1,507.32
| Professional | | $428.41 | $788.89 | $1,507.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $366.59 / $803.80 / $6,679.00
| Facility | | $366.59 | $803.80 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $684.92 / $835.63 / $1,164.58
| Professional | | $684.92 | $835.63 | $1,164.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $473.09 / $994.75 / $1,698.38
| Professional | | $473.09 | $994.75 | $1,698.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,883.61 / $3,764.00 / $16,394.00
| Facility | | $1,883.61 | $3,764.00 | $16,394.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $553.88 / $1,221.89 / $4,213.76
| Professional | | $553.88 | $1,221.89 | $4,213.76 |
- 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
- $543.73 / $923.05 / $1,979.17
| Professional | | $543.73 | $923.05 | $1,979.17 |