- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $864.86 / $2,663.12 / $4,410.00
| Facility | | $864.86 | $2,663.12 | $4,410.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $209.67 / $864.86 / $2,036.19
| Professional | | $209.67 | $864.86 | $2,036.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $797.40 / $5,268.00 / $26,542.00
| Facility | | $797.40 | $5,268.00 | $26,542.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $357.28 / $2,192.03 / $6,924.48
| Professional | | $357.28 | $2,192.03 | $6,924.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $383.46 / $498.50 / $977.82
| Facility | | $383.46 | $498.50 | $977.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $588.38 / $1,720.70 / $4,490.68
| Professional | | $588.38 | $1,720.70 | $4,490.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $325.47 / $699.20 / $6,679.00
| Facility | | $325.47 | $699.20 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,728.48 / $2,033.98 / $3,635.77
| Professional | | $1,728.48 | $2,033.98 | $3,635.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $410.42 / $1,695.74 / $4,223.41
| Professional | | $410.42 | $1,695.74 | $4,223.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,155.00 / $5,572.00 / $26,542.00
| Facility | | $2,155.00 | $5,572.00 | $26,542.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,907.88 / $3,817.52 / $10,208.65
| Professional | | $1,907.88 | $3,817.52 | $10,208.65 |
- 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
- $1,780.58 / $2,344.98 / $4,418.58
| Professional | | $1,780.58 | $2,344.98 | $4,418.58 |