- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $537.03 / $3,630.78 / $9,549.93
| Facility | | $537.03 | $3,630.78 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $446.68 / $537.03 / $1,023.29
| Professional | | $446.68 | $537.03 | $1,023.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,981.07 / $6,309.57 / $8,709.64
| Facility | | $3,981.07 | $6,309.57 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $512.86 / $758.58 / $1,288.25
| Professional | | $512.86 | $758.58 | $1,288.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $524.81 / $588.84 / $812.83
| Professional | | $524.81 | $588.84 | $812.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $645.65 / $645.65 / $645.65
| Facility | | $645.65 | $645.65 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $478.63 / $602.56 / $1,096.48
| Professional | | $478.63 | $602.56 | $1,096.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $489.78 / $616.60 / $741.31
| Professional | | $489.78 | $616.60 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $575.44 / $724.44 / $1,202.26
| Professional | | $575.44 | $724.44 | $1,202.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $489.78 / $645.65 / $1,000.00
| Facility | | $489.78 | $645.65 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $630.96 / $630.96 / $630.96
| Professional | | $630.96 | $630.96 | $630.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $457.09 / $645.65 / $3,981.07
| Facility | | $457.09 | $645.65 | $3,981.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $457.09 / $645.65 / $3,981.07
| Professional | | $457.09 | $645.65 | $3,981.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,584.89 / $3,388.44 / $7,079.46
| Facility | | $1,584.89 | $3,388.44 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $371.54 / $575.44 / $1,000.00
| Professional | | $371.54 | $575.44 | $1,000.00 |