- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $616.40 / $2,747.00 / $5,039.00
| Facility | | $616.40 | $2,747.00 | $5,039.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $463.76 / $616.40 / $984.34
| Professional | | $463.76 | $616.40 | $984.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,061.00 / $3,145.08 / $9,039.00
| Facility | | $1,061.00 | $3,145.08 | $9,039.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $480.03 / $858.47 / $3,338.16
| Professional | | $480.03 | $858.47 | $3,338.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $546.15 / $710.00 / $1,252.86
| Facility | | $546.15 | $710.00 | $1,252.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $741.13 / $1,012.00 / $1,488.54
| Professional | | $741.13 | $1,012.00 | $1,488.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,593.42 / $1,593.42 / $1,593.42
| Facility | | $1,593.42 | $1,593.42 | $1,593.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $474.00 / $965.97 / $1,744.59
| Professional | | $474.00 | $965.97 | $1,744.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $458.87 / $995.84 / $6,679.00
| Facility | | $458.87 | $995.84 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $685.29 / $866.87 / $1,196.61
| Professional | | $685.29 | $866.87 | $1,196.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $562.38 / $1,197.09 / $1,974.11
| Professional | | $562.38 | $1,197.09 | $1,974.11 |
- 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
- $617.03 / $969.58 / $4,459.52
| Professional | | $617.03 | $969.58 | $4,459.52 |
- 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
- $562.38 / $801.42 / $1,890.69
| Professional | | $562.38 | $801.42 | $1,890.69 |