- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $863.24 / $1,932.00 / $3,625.00
| Facility | | $863.24 | $1,932.00 | $3,625.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $531.79 / $604.59 / $930.66
| Professional | | $531.79 | $604.59 | $930.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,338.03 / $4,402.00 / $11,272.00
| Facility | | $1,338.03 | $4,402.00 | $11,272.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $607.11 / $1,155.50 / $6,665.40
| Professional | | $607.11 | $1,155.50 | $6,665.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $710.74 / $1,165.47 / $1,578.91
| Professional | | $710.74 | $1,165.47 | $1,578.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $612.99 / $984.74 / $1,691.31
| Professional | | $612.99 | $984.74 | $1,691.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $597.79 / $1,295.96 / $6,679.00
| Facility | | $597.79 | $1,295.96 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $685.98 / $830.94 / $1,140.44
| Professional | | $685.98 | $830.94 | $1,140.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $742.60 / $1,472.13 / $1,941.97
| Professional | | $742.60 | $1,472.13 | $1,941.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,372.21 / $1,372.21 / $1,372.21
| Professional | | $1,372.21 | $1,372.21 | $1,372.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,155.00 / $5,268.00 / $16,394.00
| Facility | | $2,155.00 | $5,268.00 | $16,394.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $645.21 / $1,155.50 / $6,665.40
| Professional | | $645.21 | $1,155.50 | $6,665.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,155.00 / $5,268.00 / $10,000.29
| Facility | | $2,155.00 | $5,268.00 | $10,000.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $629.92 / $932.86 / $1,956.76
| Professional | | $629.92 | $932.86 | $1,956.76 |