- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $868.45 / $2,094.00 / $3,990.41
| Facility | | $868.45 | $2,094.00 | $3,990.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $355.79 / $868.45 / $1,467.20
| Professional | | $355.79 | $868.45 | $1,467.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $815.47 / $3,764.00 / $12,000.00
| Facility | | $815.47 | $3,764.00 | $12,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $399.70 / $1,399.05 / $7,579.40
| Professional | | $399.70 | $1,399.05 | $7,579.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $390.86 / $508.12 / $998.65
| Facility | | $390.86 | $508.12 | $998.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $492.44 / $1,204.98 / $2,801.72
| Professional | | $492.44 | $1,204.98 | $2,801.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $336.23 / $712.70 / $6,679.00
| Facility | | $336.23 | $712.70 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $540.16 / $1,040.24 / $1,581.38
| Professional | | $540.16 | $1,040.24 | $1,581.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $431.60 / $1,039.97 / $2,308.84
| Professional | | $431.60 | $1,039.97 | $2,308.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $922.43 / $1,718.81 / $2,798.16
| Facility | | $922.43 | $1,718.81 | $2,798.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $812.91 / $812.91 / $812.91
| Professional | | $812.91 | $812.91 | $812.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,665.68 / $4,249.00 / $12,000.00
| Facility | | $1,665.68 | $4,249.00 | $12,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,030.23 / $2,316.03 / $7,579.40
| Professional | | $1,030.23 | $2,316.03 | $7,579.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,902.00 / $3,764.00 / $8,766.00
| Facility | | $1,902.00 | $3,764.00 | $8,766.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $848.83 / $1,634.20 / $3,318.78
| Professional | | $848.83 | $1,634.20 | $3,318.78 |