- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $584.30 / $2,663.12 / $4,410.00
| Facility | | $584.30 | $2,663.12 | $4,410.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $427.84 / $602.44 / $1,001.82
| Professional | | $427.84 | $602.44 | $1,001.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $967.53 / $2,411.51 / $8,498.00
| Facility | | $967.53 | $2,411.51 | $8,498.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $454.03 / $916.53 / $3,123.28
| Professional | | $454.03 | $916.53 | $3,123.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $514.10 / $668.33 / $1,179.34
| Facility | | $514.10 | $668.33 | $1,179.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $557.28 / $886.45 / $1,865.30
| Professional | | $557.28 | $886.45 | $1,865.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $432.10 / $937.40 / $6,679.00
| Facility | | $432.10 | $937.40 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $656.08 / $830.10 / $1,145.86
| Professional | | $656.08 | $830.10 | $1,145.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $533.71 / $1,119.72 / $1,648.22
| Professional | | $533.71 | $1,119.72 | $1,648.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,640.00 / $3,372.00 / $26,542.00
| Facility | | $1,640.00 | $3,372.00 | $26,542.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $687.82 / $1,138.83 / $4,247.04
| Professional | | $687.82 | $1,138.83 | $4,247.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,450.00 / $3,592.00 / $8,498.00
| Facility | | $1,450.00 | $3,592.00 | $8,498.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $623.44 / $837.88 / $1,607.76
| Professional | | $623.44 | $837.88 | $1,607.76 |