- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $545.82 / $2,747.00 / $5,011.00
| Facility | | $545.82 | $2,747.00 | $5,011.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $525.55 / $616.83 / $963.02
| Professional | | $525.55 | $616.83 | $963.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,170.63 / $3,474.48 / $26,542.00
| Facility | | $1,170.63 | $3,474.48 | $26,542.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $622.83 / $1,184.93 / $5,178.08
| Professional | | $622.83 | $1,184.93 | $5,178.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $855.84 / $2,140.21 / $2,140.21
| Professional | | $855.84 | $2,140.21 | $2,140.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $837.00 / $920.70 / $3,751.11
| Facility | | $837.00 | $920.70 | $3,751.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $523.89 / $1,004.35 / $2,142.09
| Professional | | $523.89 | $1,004.35 | $2,142.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $578.00 / $1,311.42 / $6,679.00
| Facility | | $578.00 | $1,311.42 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $699.91 / $885.21 / $1,299.17
| Professional | | $699.91 | $885.21 | $1,299.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $768.41 / $1,516.84 / $1,913.80
| Professional | | $768.41 | $1,516.84 | $1,913.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,485.00 / $5,572.00 / $26,542.00
| Facility | | $1,485.00 | $5,572.00 | $26,542.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $663.39 / $1,211.81 / $5,178.08
| Professional | | $663.39 | $1,211.81 | $5,178.08 |
- 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
- $645.28 / $872.99 / $1,983.82
| Professional | | $645.28 | $872.99 | $1,983.82 |