- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $583.58 / $2,618.00 / $3,625.00
| Facility | | $583.58 | $2,618.00 | $3,625.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $559.86 / $668.30 / $907.48
| Professional | | $559.86 | $668.30 | $907.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,170.63 / $4,983.00 / $16,394.00
| Facility | | $1,170.63 | $4,983.00 | $16,394.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $675.60 / $1,274.15 / $4,803.00
| Professional | | $675.60 | $1,274.15 | $4,803.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $605.88 / $2,140.21 / $2,140.21
| Professional | | $605.88 | $2,140.21 | $2,140.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $593.00 / $652.29 / $3,751.11
| Facility | | $593.00 | $652.29 | $3,751.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $575.10 / $1,099.98 / $2,328.88
| Professional | | $575.10 | $1,099.98 | $2,328.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $506.00 / $1,419.52 / $6,679.00
| Facility | | $506.00 | $1,419.52 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $758.35 / $958.26 / $1,407.65
| Professional | | $758.35 | $958.26 | $1,407.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $833.54 / $1,645.41 / $2,076.01
| Professional | | $833.54 | $1,645.41 | $2,076.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,485.00 / $5,572.00 / $16,394.00
| Facility | | $1,485.00 | $5,572.00 | $16,394.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $721.25 / $1,317.34 / $4,803.00
| Professional | | $721.25 | $1,317.34 | $4,803.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,485.00 / $3,245.00 / $7,608.00
| Facility | | $1,485.00 | $3,245.00 | $7,608.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $689.81 / $989.84 / $2,273.01
| Professional | | $689.81 | $989.84 | $2,273.01 |