- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $840.43 / $2,537.00 / $4,410.00
| Facility | | $840.43 | $2,537.00 | $4,410.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $487.78 / $588.74 / $992.38
| Professional | | $487.78 | $588.74 | $992.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,304.18 / $5,508.58 / $14,018.00
| Facility | | $1,304.18 | $5,508.58 | $14,018.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $591.75 / $1,008.02 / $4,188.96
| Professional | | $591.75 | $1,008.02 | $4,188.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $692.43 / $1,135.45 / $1,538.23
| Professional | | $692.43 | $1,135.45 | $1,538.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $597.20 / $961.92 / $1,642.69
| Professional | | $597.20 | $961.92 | $1,642.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $582.15 / $1,262.58 / $6,679.00
| Facility | | $582.15 | $1,262.58 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $668.02 / $809.19 / $1,111.07
| Professional | | $668.02 | $809.19 | $1,111.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $722.94 / $1,433.16 / $1,890.56
| Professional | | $722.94 | $1,433.16 | $1,890.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,436.96 / $4,436.96 / $4,546.08
| Facility | | $4,436.96 | $4,436.96 | $4,546.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $177.88 / $177.88 / $960.78
| Professional | | $177.88 | $177.88 | $960.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,167.12 / $6,078.00 / $26,542.00
| Facility | | $2,167.12 | $6,078.00 | $26,542.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $626.69 / $1,068.03 / $4,188.96
| Professional | | $626.69 | $1,068.03 | $4,188.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,386.00 / $5,904.00 / $13,017.00
| Facility | | $2,386.00 | $5,904.00 | $13,017.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $617.63 / $898.62 / $1,860.65
| Professional | | $617.63 | $898.62 | $1,860.65 |