- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $483.88 / $2,663.12 / $4,410.00
| Facility | | $483.88 | $2,663.12 | $4,410.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $330.27 / $483.88 / $837.38
| Professional | | $330.27 | $483.88 | $837.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $809.89 / $2,854.00 / $9,039.00
| Facility | | $809.89 | $2,854.00 | $9,039.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $368.90 / $672.61 / $2,386.08
| Professional | | $368.90 | $672.61 | $2,386.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $393.72 / $511.84 / $903.19
| Facility | | $393.72 | $511.84 | $903.19 |
- 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
- $365.93 / $711.50 / $1,308.60
| Professional | | $365.93 | $711.50 | $1,308.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $329.54 / $717.92 / $6,679.00
| Facility | | $329.54 | $717.92 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $536.30 / $679.49 / $941.14
| Professional | | $536.30 | $679.49 | $941.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $403.05 / $878.65 / $1,540.29
| Professional | | $403.05 | $878.65 | $1,540.29 |
- 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
- $479.26 / $833.05 / $3,822.10
| Professional | | $479.26 | $833.05 | $3,822.10 |
- 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
- $467.55 / $676.60 / $1,422.54
| Professional | | $467.55 | $676.60 | $1,422.54 |