- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $572.90 / $2,663.12 / $4,410.00
| Facility | | $572.90 | $2,663.12 | $4,410.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $506.19 / $615.04 / $855.84
| Professional | | $506.19 | $615.04 | $855.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $935.17 / $3,492.66 / $26,542.00
| Facility | | $935.17 | $3,492.66 | $26,542.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $586.44 / $1,196.40 / $4,429.52
| Professional | | $586.44 | $1,196.40 | $4,429.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $692.82 / $1,695.28 / $1,695.28
| Professional | | $692.82 | $1,695.28 | $1,695.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $680.00 / $748.00 / $3,111.82
| Facility | | $680.00 | $748.00 | $3,111.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $484.60 / $1,015.76 / $2,167.28
| Professional | | $484.60 | $1,015.76 | $2,167.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $578.00 / $1,328.78 / $6,679.00
| Facility | | $578.00 | $1,328.78 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $706.88 / $896.93 / $1,312.12
| Professional | | $706.88 | $896.93 | $1,312.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $773.32 / $1,526.53 / $2,022.31
| Professional | | $773.32 | $1,526.53 | $2,022.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,061.00 / $4,249.00 / $26,542.00
| Facility | | $1,061.00 | $4,249.00 | $26,542.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $647.45 / $1,218.33 / $4,429.52
| Professional | | $647.45 | $1,218.33 | $4,429.52 |
- 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
- $603.38 / $869.84 / $2,283.88
| Professional | | $603.38 | $869.84 | $2,283.88 |