- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $375.91 / $1,245.00 / $8,413.00
| Facility | | $375.91 | $1,245.00 | $8,413.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $375.91 / $401.20 / $762.17
| Professional | | $375.91 | $401.20 | $762.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,015.30 / $2,015.30 / $2,044.70
| Facility | | $2,015.30 | $2,015.30 | $2,044.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $421.05 / $595.42 / $1,029.85
| Professional | | $421.05 | $595.42 | $1,029.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $606.10 / $606.10 / $6,025.59
| Facility | | $606.10 | $606.10 | $6,025.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $392.32 / $545.07 / $976.85
| Professional | | $392.32 | $545.07 | $976.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $375.91 / $486.60 / $849.56
| Facility | | $375.91 | $486.60 | $849.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $443.72 / $491.00 / $606.00
| Professional | | $443.72 | $491.00 | $606.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.00 / $528.40 / $1,035.90
| Professional | | $3.00 | $528.40 | $1,035.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,661.00 / $7,659.00 / $10,502.00
| Facility | | $1,661.00 | $7,659.00 | $10,502.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $322.92 / $448.18 / $935.05
| Professional | | $322.92 | $448.18 | $935.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,489.92 / $19,913.50 / $26,542.00
| Facility | | $1,489.92 | $19,913.50 | $26,542.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,435.90 / $3,768.98 / $3,768.98
| Professional | | $3,435.90 | $3,768.98 | $3,768.98 |