- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $579.36 / $3,107.00 / $7,625.00
| Facility | | $579.36 | $3,107.00 | $7,625.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $456.34 / $605.61 / $908.53
| Professional | | $456.34 | $605.61 | $908.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,061.00 / $3,483.12 / $11,217.00
| Facility | | $1,061.00 | $3,483.12 | $11,217.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $612.80 / $1,161.69 / $4,734.88
| Professional | | $612.80 | $1,161.69 | $4,734.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $612.69 / $787.31 / $1,405.51
| Facility | | $612.69 | $787.31 | $1,405.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $591.00 / $1,053.78 / $1,904.13
| Professional | | $591.00 | $1,053.78 | $1,904.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $510.63 / $1,117.16 / $6,679.00
| Facility | | $510.63 | $1,117.16 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $764.35 / $932.54 / $1,291.80
| Professional | | $764.35 | $932.54 | $1,291.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $643.20 / $1,361.07 / $1,903.61
| Professional | | $643.20 | $1,361.07 | $1,903.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,902.00 / $3,764.00 / $26,542.00
| Facility | | $1,902.00 | $3,764.00 | $26,542.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $726.40 / $1,396.38 / $4,734.88
| Professional | | $726.40 | $1,396.38 | $4,734.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,902.00 / $3,764.00 / $8,766.00
| Facility | | $1,902.00 | $3,764.00 | $8,766.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $655.72 / $989.20 / $2,046.47
| Professional | | $655.72 | $989.20 | $2,046.47 |