- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $791.49 / $2,663.12 / $4,109.35
| Facility | | $791.49 | $2,663.12 | $4,109.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $193.33 / $791.49 / $1,606.45
| Professional | | $193.33 | $791.49 | $1,606.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $445.22 / $3,006.00 / $6,652.46
| Facility | | $445.22 | $3,006.00 | $6,652.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $211.74 / $1,641.78 / $4,911.32
| Professional | | $211.74 | $1,641.78 | $4,911.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $218.38 / $277.12 / $500.96
| Facility | | $218.38 | $277.12 | $500.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $218.38 / $730.48 / $2,086.40
| Professional | | $218.38 | $730.48 | $2,086.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $241.73 / $569.11 / $2,741.63
| Professional | | $241.73 | $569.11 | $2,741.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $188.42 / $298.64 / $6,679.00
| Facility | | $188.42 | $298.64 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,091.67 / $1,429.40 / $2,466.37
| Professional | | $1,091.67 | $1,429.40 | $2,466.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $278.91 / $1,014.94 / $2,866.63
| Professional | | $278.91 | $1,014.94 | $2,866.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,365.69 / $2,365.69 / $2,365.69
| Facility | | $2,365.69 | $2,365.69 | $2,365.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,485.00 / $3,110.00 / $7,608.00
| Facility | | $1,485.00 | $3,110.00 | $7,608.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,167.29 / $2,393.91 / $6,685.04
| Professional | | $1,167.29 | $2,393.91 | $6,685.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,155.00 / $4,983.00 / $8,810.00
| Facility | | $2,155.00 | $4,983.00 | $8,810.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,087.61 / $1,952.27 / $3,760.95
| Professional | | $1,087.61 | $1,952.27 | $3,760.95 |