- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $559.39 / $1,924.00 / $5,003.00
| Facility | | $559.39 | $1,924.00 | $5,003.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $330.50 / $472.99 / $1,144.97
| Professional | | $330.50 | $472.99 | $1,144.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $911.00 / $5,063.00 / $16,742.00
| Facility | | $911.00 | $5,063.00 | $16,742.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $422.88 / $961.80 / $3,936.22
| Professional | | $422.88 | $961.80 | $3,936.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $462.08 / $600.70 / $1,060.01
| Facility | | $462.08 | $600.70 | $1,060.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $551.66 / $1,013.97 / $1,984.33
| Professional | | $551.66 | $1,013.97 | $1,984.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $392.09 / $842.56 / $6,679.00
| Facility | | $392.09 | $842.56 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $605.48 / $765.09 / $1,367.93
| Professional | | $605.48 | $765.09 | $1,367.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $496.67 / $1,064.97 / $1,434.96
| Professional | | $496.67 | $1,064.97 | $1,434.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,324.00 / $6,204.00 / $26,542.00
| Facility | | $2,324.00 | $6,204.00 | $26,542.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $674.36 / $1,396.46 / $3,936.22
| Professional | | $674.36 | $1,396.46 | $3,936.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,324.00 / $5,097.00 / $10,764.00
| Facility | | $2,324.00 | $5,097.00 | $10,764.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $653.86 / $856.85 / $2,114.33
| Professional | | $653.86 | $856.85 | $2,114.33 |