- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $461.06 / $2,079.00 / $3,625.00
| Facility | | $461.06 | $2,079.00 | $3,625.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $431.04 / $500.68 / $1,051.81
| Professional | | $431.04 | $500.68 | $1,051.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $998.97 / $3,764.00 / $12,000.00
| Facility | | $998.97 | $3,764.00 | $12,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $393.20 / $946.16 / $4,093.34
| Professional | | $393.20 | $946.16 | $4,093.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $502.40 / $652.12 / $1,152.51
| Facility | | $502.40 | $652.12 | $1,152.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $586.29 / $893.67 / $1,716.15
| Professional | | $586.29 | $893.67 | $1,716.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $427.09 / $916.08 / $6,679.00
| Facility | | $427.09 | $916.08 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $283.93 / $527.49 / $850.43
| Professional | | $283.93 | $527.49 | $850.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $530.02 / $1,067.46 / $1,443.94
| Professional | | $530.02 | $1,067.46 | $1,443.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,902.00 / $4,249.00 / $12,000.00
| Facility | | $1,902.00 | $4,249.00 | $12,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $541.29 / $1,340.45 / $4,093.34
| Professional | | $541.29 | $1,340.45 | $4,093.34 |
- 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
- $520.05 / $846.11 / $1,637.13
| Professional | | $520.05 | $846.11 | $1,637.13 |