- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $523.39 / $2,618.00 / $3,625.00
| Facility | | $523.39 | $2,618.00 | $3,625.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $449.29 / $564.28 / $774.77
| Professional | | $449.29 | $564.28 | $774.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $935.17 / $3,212.46 / $16,394.00
| Facility | | $935.17 | $3,212.46 | $16,394.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $537.16 / $1,081.58 / $4,079.92
| Professional | | $537.16 | $1,081.58 | $4,079.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $605.88 / $1,695.28 / $1,695.28
| Professional | | $605.88 | $1,695.28 | $1,695.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $593.00 / $652.29 / $3,111.82
| Facility | | $593.00 | $652.29 | $3,111.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $482.02 / $931.53 / $1,995.75
| Professional | | $482.02 | $931.53 | $1,995.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $506.00 / $1,229.74 / $6,679.00
| Facility | | $506.00 | $1,229.74 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $652.46 / $830.07 / $1,199.00
| Professional | | $652.46 | $830.07 | $1,199.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $711.88 / $1,405.25 / $1,861.64
| Professional | | $711.88 | $1,405.25 | $1,861.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,061.00 / $4,249.00 / $16,394.00
| Facility | | $1,061.00 | $4,249.00 | $16,394.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $590.79 / $1,113.48 / $4,079.92
| Professional | | $590.79 | $1,113.48 | $4,079.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,061.00 / $2,854.00 / $5,714.00
| Facility | | $1,061.00 | $2,854.00 | $5,714.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $549.29 / $797.34 / $1,936.71
| Professional | | $549.29 | $797.34 | $1,936.71 |