- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $540.84 / $2,663.12 / $3,625.00
| Facility | | $540.84 | $2,663.12 | $3,625.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $413.44 / $540.84 / $857.12
| Professional | | $413.44 | $540.84 | $857.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $972.73 / $4,287.00 / $10,138.40
| Facility | | $972.73 | $4,287.00 | $10,138.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $417.69 / $749.47 / $2,977.04
| Professional | | $417.69 | $749.47 | $2,977.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $486.66 / $632.66 / $1,116.40
| Facility | | $486.66 | $632.66 | $1,116.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $605.88 / $605.88 / $2,160.52
| Professional | | $605.88 | $605.88 | $2,160.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,082.51 / $2,082.51 / $2,082.51
| Facility | | $2,082.51 | $2,082.51 | $2,082.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $416.49 / $840.58 / $1,545.10
| Professional | | $416.49 | $840.58 | $1,545.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $408.94 / $887.38 / $6,679.00
| Facility | | $408.94 | $887.38 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $596.37 / $753.79 / $1,040.53
| Professional | | $596.37 | $753.79 | $1,040.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $500.94 / $1,059.74 / $1,718.12
| Professional | | $500.94 | $1,059.74 | $1,718.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,155.00 / $4,983.00 / $16,394.00
| Facility | | $2,155.00 | $4,983.00 | $16,394.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $539.10 / $843.30 / $3,886.08
| Professional | | $539.10 | $843.30 | $3,886.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,155.00 / $4,402.00 / $8,810.00
| Facility | | $2,155.00 | $4,402.00 | $8,810.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $523.01 / $722.92 / $1,567.97
| Professional | | $523.01 | $722.92 | $1,567.97 |