- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $466.45 / $2,663.12 / $4,410.00
| Facility | | $466.45 | $2,663.12 | $4,410.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $370.05 / $466.45 / $735.99
| Professional | | $370.05 | $466.45 | $735.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $873.59 / $2,854.00 / $9,039.00
| Facility | | $873.59 | $2,854.00 | $9,039.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $359.21 / $667.99 / $2,670.80
| Professional | | $359.21 | $667.99 | $2,670.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $437.24 / $567.54 / $1,003.03
| Facility | | $437.24 | $567.54 | $1,003.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $692.82 / $692.82 / $1,316.29
| Professional | | $692.82 | $692.82 | $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
- $375.84 / $754.13 / $1,364.79
| Professional | | $375.84 | $754.13 | $1,364.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $367.28 / $797.26 / $6,679.00
| Facility | | $367.28 | $797.26 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $515.45 / $650.92 / $898.53
| Professional | | $515.45 | $650.92 | $898.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $450.15 / $943.17 / $1,494.50
| Professional | | $450.15 | $943.17 | $1,494.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,685.00 / $3,764.00 / $26,542.00
| Facility | | $1,685.00 | $3,764.00 | $26,542.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $476.69 / $796.69 / $3,748.10
| Professional | | $476.69 | $796.69 | $3,748.10 |
- 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
- $455.16 / $642.17 / $1,404.16
| Professional | | $455.16 | $642.17 | $1,404.16 |