- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $544.57 / $2,747.00 / $5,039.00
| Facility | | $544.57 | $2,747.00 | $5,039.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $440.13 / $556.74 / $861.02
| Professional | | $440.13 | $556.74 | $861.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,039.72 / $2,989.68 / $9,039.00
| Facility | | $1,039.72 | $2,989.68 | $9,039.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $422.32 / $775.63 / $3,604.00
| Professional | | $422.32 | $775.63 | $3,604.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $518.64 / $673.19 / $1,189.76
| Facility | | $518.64 | $673.19 | $1,189.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $855.84 / $855.84 / $1,316.29
| Professional | | $855.84 | $855.84 | $1,316.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,346.32 / $1,346.32 / $1,346.32
| Facility | | $1,346.32 | $1,346.32 | $1,346.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $468.90 / $877.02 / $1,625.07
| Professional | | $468.90 | $877.02 | $1,625.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $436.00 / $945.68 / $6,679.00
| Facility | | $436.00 | $945.68 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $603.89 / $761.83 / $1,051.61
| Professional | | $603.89 | $761.83 | $1,051.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $534.94 / $1,119.42 / $1,772.43
| Professional | | $534.94 | $1,119.42 | $1,772.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,685.00 / $3,764.00 / $26,542.00
| Facility | | $1,685.00 | $3,764.00 | $26,542.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $579.45 / $891.10 / $4,659.41
| Professional | | $579.45 | $891.10 | $4,659.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,685.00 / $3,997.00 / $9,039.00
| Facility | | $1,685.00 | $3,997.00 | $9,039.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $549.35 / $757.02 / $1,625.18
| Professional | | $549.35 | $757.02 | $1,625.18 |