- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $522.33 / $2,663.12 / $4,410.00
| Facility | | $522.33 | $2,663.12 | $4,410.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $460.86 / $522.33 / $748.85
| Professional | | $460.86 | $522.33 | $748.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,196.84 / $4,628.72 / $26,542.00
| Facility | | $1,196.84 | $4,628.72 | $26,542.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $526.77 / $977.08 / $4,794.81
| Professional | | $526.77 | $977.08 | $4,794.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $692.82 / $3,212.69 / $3,212.69
| Professional | | $692.82 | $3,212.69 | $3,212.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $680.00 / $748.00 / $6,493.89
| Facility | | $680.00 | $748.00 | $6,493.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $455.00 / $815.04 / $1,568.41
| Professional | | $455.00 | $815.04 | $1,568.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $495.52 / $1,075.26 / $6,679.00
| Facility | | $495.52 | $1,075.26 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $568.61 / $725.80 / $1,142.60
| Professional | | $568.61 | $725.80 | $1,142.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $611.12 / $1,206.34 / $1,557.74
| Professional | | $611.12 | $1,206.34 | $1,557.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,591.00 / $6,204.00 / $26,542.00
| Facility | | $1,591.00 | $6,204.00 | $26,542.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $570.99 / $977.08 / $4,794.81
| Professional | | $570.99 | $977.08 | $4,794.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,591.00 / $4,006.00 / $10,764.00
| Facility | | $1,591.00 | $4,006.00 | $10,764.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $542.91 / $820.34 / $1,723.75
| Professional | | $542.91 | $820.34 | $1,723.75 |