- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $586.25 / $2,747.00 / $5,039.00
| Facility | | $586.25 | $2,747.00 | $5,039.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $461.92 / $586.25 / $926.33
| Professional | | $461.92 | $586.25 | $926.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,089.39 / $4,287.00 / $10,138.40
| Facility | | $1,089.39 | $4,287.00 | $10,138.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $450.40 / $812.05 / $3,329.52
| Professional | | $450.40 | $812.05 | $3,329.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $540.16 / $701.13 / $1,239.13
| Facility | | $540.16 | $701.13 | $1,239.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $701.12 / $969.53 / $1,525.43
| Professional | | $701.12 | $969.53 | $1,525.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,082.51 / $2,082.51 / $2,082.51
| Facility | | $2,082.51 | $2,082.51 | $2,082.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $465.28 / $917.64 / $1,705.53
| Professional | | $465.28 | $917.64 | $1,705.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $455.57 / $984.92 / $6,679.00
| Facility | | $455.57 | $984.92 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $647.13 / $814.99 / $1,125.01
| Professional | | $647.13 | $814.99 | $1,125.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $559.51 / $1,173.84 / $1,869.14
| Professional | | $559.51 | $1,173.84 | $1,869.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,155.00 / $4,983.00 / $26,542.00
| Facility | | $2,155.00 | $4,983.00 | $26,542.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $572.55 / $907.56 / $4,233.76
| Professional | | $572.55 | $907.56 | $4,233.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,155.00 / $4,402.00 / $8,810.00
| Facility | | $2,155.00 | $4,402.00 | $8,810.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $552.67 / $749.58 / $1,726.42
| Professional | | $552.67 | $749.58 | $1,726.42 |