- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $527.20 / $2,663.12 / $3,693.00
| Facility | | $527.20 | $2,663.12 | $3,693.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $270.26 / $527.20 / $966.59
| Professional | | $270.26 | $527.20 | $966.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $620.20 / $3,764.00 / $12,379.00
| Facility | | $620.20 | $3,764.00 | $12,379.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $302.11 / $1,080.53 / $9,395.39
| Professional | | $302.11 | $1,080.53 | $9,395.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $297.45 / $386.70 / $758.52
| Facility | | $297.45 | $386.70 | $758.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $387.05 / $881.00 / $1,887.87
| Professional | | $387.05 | $881.00 | $1,887.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $260.76 / $542.40 / $6,679.00
| Facility | | $260.76 | $542.40 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $365.79 / $704.42 / $1,121.96
| Professional | | $365.79 | $704.42 | $1,121.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $327.90 / $708.58 / $1,570.45
| Professional | | $327.90 | $708.58 | $1,570.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,778.34 / $4,249.00 / $16,394.00
| Facility | | $1,778.34 | $4,249.00 | $16,394.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $816.61 / $2,025.39 / $9,395.39
| Professional | | $816.61 | $2,025.39 | $9,395.39 |
- 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
- $707.38 / $1,123.90 / $2,694.34
| Professional | | $707.38 | $1,123.90 | $2,694.34 |