- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $417.93 / $3,086.18 / $7,278.00
| Facility | | $417.93 | $3,086.18 | $7,278.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $404.31 / $427.02 / $746.03
| Professional | | $404.31 | $427.02 | $746.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,267.27 / $2,493.98 / $4,232.22
| Facility | | $2,267.27 | $2,493.98 | $4,232.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $502.47 / $749.03 / $1,185.18
| Professional | | $502.47 | $749.03 | $1,185.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $338.41 / $3,092.24 / $5,833.50
| Facility | | $338.41 | $3,092.24 | $5,833.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $474.91 / $640.55 / $1,124.68
| Professional | | $474.91 | $640.55 | $1,124.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $417.93 / $524.54 / $773.17
| Facility | | $417.93 | $524.54 | $773.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $380.00 / $415.00 / $1,648.42
| Professional | | $380.00 | $415.00 | $1,648.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $448.90 / $511.10 / $936.00
| Professional | | $448.90 | $511.10 | $936.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,746.00 / $6,492.00 / $18,665.00
| Facility | | $1,746.00 | $6,492.00 | $18,665.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $378.30 / $498.80 / $1,059.07
| Professional | | $378.30 | $498.80 | $1,059.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,691.50 / $12,000.00 / $17,070.15
| Facility | | $2,691.50 | $12,000.00 | $17,070.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,534.15 / $5,296.80 / $5,296.80
| Professional | | $3,534.15 | $5,296.80 | $5,296.80 |