- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $643.52 / $2,747.00 / $5,039.00
| Facility | | $643.52 | $2,747.00 | $5,039.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $456.49 / $640.50 / $1,008.69
| Professional | | $456.49 | $640.50 | $1,008.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,061.00 / $2,854.00 / $9,039.00
| Facility | | $1,061.00 | $2,854.00 | $9,039.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $531.38 / $1,102.49 / $4,810.08
| Professional | | $531.38 | $1,102.49 | $4,810.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $571.04 / $733.79 / $1,309.97
| Facility | | $571.04 | $733.79 | $1,309.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $783.39 / $1,098.31 / $1,704.42
| Professional | | $783.39 | $1,098.31 | $1,704.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $614.34 / $994.76 / $1,844.83
| Professional | | $614.34 | $994.76 | $1,844.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $487.89 / $1,041.24 / $6,679.00
| Facility | | $487.89 | $1,041.24 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $756.76 / $916.69 / $1,257.01
| Professional | | $756.76 | $916.69 | $1,257.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $619.26 / $1,317.07 / $1,885.50
| Professional | | $619.26 | $1,317.07 | $1,885.50 |
- 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
- $745.40 / $1,428.42 / $4,810.08
| Professional | | $745.40 | $1,428.42 | $4,810.08 |
- 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
- $692.92 / $1,038.36 / $1,947.72
| Professional | | $692.92 | $1,038.36 | $1,947.72 |