- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $604.66 / $2,747.00 / $5,039.00
| Facility | | $604.66 | $2,747.00 | $5,039.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $432.50 / $604.66 / $972.31
| Professional | | $432.50 | $604.66 | $972.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,017.80 / $2,939.88 / $9,039.00
| Facility | | $1,017.80 | $2,939.88 | $9,039.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $471.61 / $844.94 / $3,284.00
| Professional | | $471.61 | $844.94 | $3,284.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $510.00 / $663.00 / $1,169.94
| Facility | | $510.00 | $663.00 | $1,169.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $715.02 / $1,017.96 / $1,513.33
| Professional | | $715.02 | $1,017.96 | $1,513.33 |
- 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
- $450.92 / $915.57 / $1,627.21
| Professional | | $450.92 | $915.57 | $1,627.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $428.75 / $929.94 / $6,679.00
| Facility | | $428.75 | $929.94 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $669.08 / $847.07 / $1,169.29
| Professional | | $669.08 | $847.07 | $1,169.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $525.92 / $1,140.74 / $1,926.99
| Professional | | $525.92 | $1,140.74 | $1,926.99 |
- 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
- $606.96 / $1,045.04 / $5,110.01
| Professional | | $606.96 | $1,045.04 | $5,110.01 |
- 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
- $598.50 / $794.52 / $1,736.09
| Professional | | $598.50 | $794.52 | $1,736.09 |