- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $482.92 / $2,663.12 / $3,625.00
| Facility | | $482.92 | $2,663.12 | $3,625.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $428.21 / $506.18 / $739.34
| Professional | | $428.21 | $506.18 | $739.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $979.16 / $2,854.00 / $9,039.00
| Facility | | $979.16 | $2,854.00 | $9,039.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $356.79 / $642.46 / $2,976.88
| Professional | | $356.79 | $642.46 | $2,976.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $490.35 / $636.47 / $1,124.85
| Facility | | $490.35 | $636.47 | $1,124.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $605.88 / $605.88 / $1,316.29
| Professional | | $605.88 | $605.88 | $1,316.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,346.32 / $1,346.32 / $1,346.32
| Facility | | $1,346.32 | $1,346.32 | $1,346.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $412.89 / $816.02 / $1,462.92
| Professional | | $412.89 | $816.02 | $1,462.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $410.66 / $894.10 / $6,679.00
| Facility | | $410.66 | $894.10 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $517.48 / $652.92 / $901.30
| Professional | | $517.48 | $652.92 | $901.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $502.17 / $1,032.81 / $1,536.64
| Professional | | $502.17 | $1,032.81 | $1,536.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,685.00 / $3,764.00 / $16,394.00
| Facility | | $1,685.00 | $3,764.00 | $16,394.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $477.13 / $719.54 / $3,377.68
| Professional | | $477.13 | $719.54 | $3,377.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,685.00 / $3,715.00 / $8,766.00
| Facility | | $1,685.00 | $3,715.00 | $8,766.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $461.97 / $610.92 / $1,433.28
| Professional | | $461.97 | $610.92 | $1,433.28 |