- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,023.29 / $2,884.03 / $4,897.79
| Facility | | $1,023.29 | $2,884.03 | $4,897.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.93 / $933.25 / $2,344.23
| Professional | | $208.93 | $933.25 | $2,344.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $741.31 / $3,715.35
| Facility | | $56.23 | $741.31 | $3,715.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $218.78 / $1,000.00 / $3,630.78
| Professional | | $218.78 | $1,000.00 | $3,630.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $239.88 / $239.88 / $549.54
| Facility | | $239.88 | $239.88 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $263.03 / $758.58 / $3,715.35
| Professional | | $263.03 | $758.58 | $3,715.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $177.83 / $302.00 / $7,079.46
| Facility | | $177.83 | $302.00 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $794.33 / $1,479.11 / $2,238.72
| Professional | | $794.33 | $1,479.11 | $2,238.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $630.96 / $2,041.74 / $3,467.37
| Facility | | $630.96 | $2,041.74 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $223.87 / $1,288.25 / $3,235.94
| Professional | | $223.87 | $1,288.25 | $3,235.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,174.90 / $1,174.90 / $1,174.90
| Facility | | $1,174.90 | $1,174.90 | $1,174.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $741.31 / $3,715.35
| Facility | | $56.23 | $741.31 | $3,715.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $218.78 / $1,000.00 / $3,630.78
| Professional | | $218.78 | $1,000.00 | $3,630.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $630.96 / $1,862.09 / $2,818.38
| Facility | | $630.96 | $1,862.09 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $263.03 / $933.25 / $3,311.31
| Professional | | $263.03 | $933.25 | $3,311.31 |