- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $652.04 / $2,933.89 / $3,973.92
| Facility | | $652.04 | $2,933.89 | $3,973.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $479.76 / $858.75 / $1,145.00
| Professional | | $479.76 | $858.75 | $1,145.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $619.41 / $1,980.79 / $6,193.76
| Facility | | $619.41 | $1,980.79 | $6,193.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $407.43 / $679.05 / $2,549.85
| Professional | | $407.43 | $679.05 | $2,549.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,332.41 / $1,905.35 / $3,331.03
| Facility | | $1,332.41 | $1,905.35 | $3,331.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,225.71 / $1,225.71 / $1,264.83
| Professional | | $1,225.71 | $1,225.71 | $1,264.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $474.50 / $669.18 / $1,544.83
| Facility | | $474.50 | $669.18 | $1,544.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $407.46 / $679.05 / $3,367.57
| Professional | | $407.46 | $679.05 | $3,367.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $83.43 / $4,618.00 / $9,239.00
| Facility | | $83.43 | $4,618.00 | $9,239.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,881.45 / $1,881.45 / $2,213.46
| Professional | | $1,881.45 | $1,881.45 | $2,213.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,303.95 / $1,303.95 / $2,208.10
| Professional | | $1,303.95 | $1,303.95 | $2,208.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,872.00 / $1,872.00 / $1,872.00
| Facility | | $1,872.00 | $1,872.00 | $1,872.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,268.87 / $6,193.76 / $6,193.76
| Facility | | $2,268.87 | $6,193.76 | $6,193.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $407.43 / $558.89 / $6,493.67
| Professional | | $407.43 | $558.89 | $6,493.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $391.19 / $558.89 / $1,403.46
| Professional | | $391.19 | $558.89 | $1,403.46 |