- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $651.35 / $2,894.00 / $6,075.00
| Facility | | $651.35 | $2,894.00 | $6,075.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $590.20 / $670.03 / $969.38
| Professional | | $590.20 | $670.03 | $969.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,598.89 / $4,896.56 / $18,608.08
| Facility | | $1,598.89 | $4,896.56 | $18,608.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $705.56 / $1,193.72 / $4,640.39
| Professional | | $705.56 | $1,193.72 | $4,640.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $758.18 / $1,243.33 / $1,772.62
| Professional | | $758.18 | $1,243.33 | $1,772.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $680.00 / $748.00 / $15,621.37
| Facility | | $680.00 | $748.00 | $15,621.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $627.48 / $1,086.56 / $2,262.02
| Professional | | $627.48 | $1,086.56 | $2,262.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $578.00 / $1,382.46 / $6,679.00
| Facility | | $578.00 | $1,382.46 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $738.53 / $933.22 / $1,430.14
| Professional | | $738.53 | $933.22 | $1,430.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $811.83 / $1,602.55 / $2,021.94
| Professional | | $811.83 | $1,602.55 | $2,021.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,697.00 / $4,671.00 / $21,130.00
| Facility | | $1,697.00 | $4,671.00 | $21,130.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $738.04 / $1,185.81 / $4,640.39
| Professional | | $738.04 | $1,185.81 | $4,640.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,697.00 / $4,671.00 / $13,017.00
| Facility | | $1,697.00 | $4,671.00 | $13,017.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $702.65 / $997.66 / $2,214.12
| Professional | | $702.65 | $997.66 | $2,214.12 |