- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $523.33 / $2,663.12 / $3,625.00
| Facility | | $523.33 | $2,663.12 | $3,625.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $368.77 / $523.33 / $757.09
| Professional | | $368.77 | $523.33 | $757.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $892.87 / $2,569.44 / $8,498.00
| Facility | | $892.87 | $2,569.44 | $8,498.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $411.38 / $811.05 / $3,019.00
| Professional | | $411.38 | $811.05 | $3,019.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $447.59 / $581.87 / $1,026.77
| Facility | | $447.59 | $581.87 | $1,026.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $485.19 / $802.75 / $1,682.33
| Professional | | $485.19 | $802.75 | $1,682.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $375.28 / $816.14 / $6,679.00
| Facility | | $375.28 | $816.14 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $589.13 / $746.41 / $1,031.66
| Professional | | $589.13 | $746.41 | $1,031.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $461.62 / $977.25 / $1,562.05
| Professional | | $461.62 | $977.25 | $1,562.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,640.00 / $3,372.00 / $16,394.00
| Facility | | $1,640.00 | $3,372.00 | $16,394.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $579.22 / $1,015.54 / $3,808.80
| Professional | | $579.22 | $1,015.54 | $3,808.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,640.00 / $3,372.00 / $8,425.00
| Facility | | $1,640.00 | $3,372.00 | $8,425.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $531.69 / $723.79 / $1,612.55
| Professional | | $531.69 | $723.79 | $1,612.55 |