- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $456.47 / $2,747.00 / $5,039.00
| Facility | | $456.47 | $2,747.00 | $5,039.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $408.65 / $494.93 / $723.21
| Professional | | $408.65 | $494.93 | $723.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $941.10 / $2,000.17 / $8,498.00
| Facility | | $941.10 | $2,000.17 | $8,498.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $347.30 / $642.44 / $2,940.80
| Professional | | $347.30 | $642.44 | $2,940.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $480.84 / $624.13 / $1,103.05
| Facility | | $480.84 | $624.13 | $1,103.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $601.79 / $855.84 / $1,154.98
| Professional | | $601.79 | $855.84 | $1,154.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $650.80 / $650.80 / $650.80
| Facility | | $650.80 | $650.80 | $650.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $407.66 / $781.96 / $1,424.66
| Professional | | $407.66 | $781.96 | $1,424.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $403.99 / $876.76 / $6,679.00
| Facility | | $403.99 | $876.76 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $502.92 / $632.49 / $873.08
| Professional | | $502.92 | $632.49 | $873.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $494.80 / $1,017.66 / $1,501.02
| Professional | | $494.80 | $1,017.66 | $1,501.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,245.00 / $3,372.00 / $26,542.00
| Facility | | $1,245.00 | $3,372.00 | $26,542.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $470.35 / $700.10 / $3,296.24
| Professional | | $470.35 | $700.10 | $3,296.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,245.00 / $3,372.00 / $8,425.00
| Facility | | $1,245.00 | $3,372.00 | $8,425.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $443.68 / $594.36 / $1,306.40
| Professional | | $443.68 | $594.36 | $1,306.40 |