- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $555.83 / $2,663.12 / $3,737.84
| Facility | | $555.83 | $2,663.12 | $3,737.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $132.75 / $555.83 / $1,321.76
| Professional | | $132.75 | $555.83 | $1,321.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $436.75 / $5,268.00 / $16,394.00
| Facility | | $436.75 | $5,268.00 | $16,394.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $193.47 / $1,153.32 / $3,748.42
| Professional | | $193.47 | $1,153.32 | $3,748.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $207.80 / $270.14 / $529.89
| Facility | | $207.80 | $270.14 | $529.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $317.93 / $912.35 / $1,894.68
| Professional | | $317.93 | $912.35 | $1,894.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $321.29 / $951.95 / $2,357.09
| Professional | | $321.29 | $951.95 | $2,357.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $181.28 / $378.90 / $6,679.00
| Facility | | $181.28 | $378.90 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $919.13 / $1,083.28 / $1,936.83
| Professional | | $919.13 | $1,083.28 | $1,936.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $222.00 / $901.53 / $2,245.35
| Professional | | $222.00 | $901.53 | $2,245.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,867.80 / $2,867.80 / $2,867.80
| Facility | | $2,867.80 | $2,867.80 | $2,867.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,485.00 / $5,572.00 / $16,394.00
| Facility | | $1,485.00 | $5,572.00 | $16,394.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,004.84 / $2,031.19 / $5,267.92
| Professional | | $1,004.84 | $2,031.19 | $5,267.92 |
- 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
- $963.88 / $1,433.63 / $3,660.41
| Professional | | $963.88 | $1,433.63 | $3,660.41 |