- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $594.00 / $2,371.00 / $7,799.00
| Facility | | $594.00 | $2,371.00 | $7,799.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $496.07 / $556.28 / $711.44
| Professional | | $496.07 | $556.28 | $711.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,058.35 / $6,182.00 / $17,094.48
| Facility | | $5,058.35 | $6,182.00 | $17,094.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $491.78 / $784.63 / $1,067.59
| Professional | | $491.78 | $784.63 | $1,067.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $537.57 / $735.45 / $1,146.14
| Professional | | $537.57 | $735.45 | $1,146.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $645.23 / $853.51 / $853.51
| Professional | | $645.23 | $853.51 | $853.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $641.00 / $2,371.00 / $8,017.00
| Facility | | $641.00 | $2,371.00 | $8,017.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $496.07 / $593.71 / $2,843.00
| Professional | | $496.07 | $593.71 | $2,843.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.00 / $767.20 / $1,371.20
| Professional | | $7.00 | $767.20 | $1,371.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $559.54 / $740.29 / $1,285.14
| Professional | | $559.54 | $740.29 | $1,285.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $542.86 / $542.86 / $860.36
| Facility | | $542.86 | $542.86 | $860.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $525.17 / $546.83 / $860.36
| Professional | | $525.17 | $546.83 | $860.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $814.00 / $2,391.00 / $4,789.00
| Facility | | $814.00 | $2,391.00 | $4,789.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $553.69 / $695.40 / $1,163.77
| Professional | | $553.69 | $695.40 | $1,163.77 |