- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $911.62 / $2,663.12 / $3,693.00
| Facility | | $911.62 | $2,663.12 | $3,693.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $263.95 / $911.62 / $1,889.85
| Professional | | $263.95 | $911.62 | $1,889.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $640.07 / $3,006.00 / $6,652.46
| Facility | | $640.07 | $3,006.00 | $6,652.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $306.00 / $1,980.15 / $5,835.69
| Professional | | $306.00 | $1,980.15 | $5,835.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $315.85 / $400.81 / $724.56
| Facility | | $315.85 | $400.81 | $724.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $442.82 / $1,753.49 / $2,938.67
| Professional | | $442.82 | $1,753.49 | $2,938.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $348.43 / $773.35 / $3,238.68
| Professional | | $348.43 | $773.35 | $3,238.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $214.32 / $407.69 / $6,679.00
| Facility | | $214.32 | $407.69 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,383.74 / $1,811.82 / $3,126.22
| Professional | | $1,383.74 | $1,811.82 | $3,126.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $401.49 / $1,460.83 / $3,639.89
| Professional | | $401.49 | $1,460.83 | $3,639.89 |
- 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
- $1,426.14 / $2,945.66 / $8,472.40
| Professional | | $1,426.14 | $2,945.66 | $8,472.40 |
- 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
- $1,282.99 / $2,337.69 / $5,728.34
| Professional | | $1,282.99 | $2,337.69 | $5,728.34 |