- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $634.83 / $2,747.00 / $5,011.00
| Facility | | $634.83 | $2,747.00 | $5,011.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $566.87 / $634.83 / $961.94
| Professional | | $566.87 | $634.83 | $961.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $896.80 / $3,895.00 / $26,542.00
| Facility | | $896.80 | $3,895.00 | $26,542.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $650.78 / $1,197.80 / $5,901.04
| Professional | | $650.78 | $1,197.80 | $5,901.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $855.84 / $1,620.25 / $1,620.25
| Professional | | $855.84 | $1,620.25 | $1,620.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $837.00 / $920.70 / $3,103.98
| Facility | | $837.00 | $920.70 | $3,103.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $516.40 / $1,008.87 / $1,918.33
| Professional | | $516.40 | $1,008.87 | $1,918.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $607.34 / $1,313.14 / $6,679.00
| Facility | | $607.34 | $1,313.14 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $696.92 / $886.37 / $1,398.84
| Professional | | $696.92 | $886.37 | $1,398.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $751.62 / $1,483.70 / $1,915.88
| Professional | | $751.62 | $1,483.70 | $1,915.88 |
- 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
- $699.23 / $1,199.96 / $5,901.04
| Professional | | $699.23 | $1,199.96 | $5,901.04 |
- 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
- $669.72 / $1,001.18 / $2,578.21
| Professional | | $669.72 | $1,001.18 | $2,578.21 |