- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $690.33 / $4,962.67 / $15,341.00
| Facility | | $690.33 | $4,962.67 | $15,341.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $230.73 / $436.22 / $1,012.21
| Professional | | $230.73 | $436.22 | $1,012.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $463.05 / $804.75 / $1,340.09
| Professional | | $463.05 | $804.75 | $1,340.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $508.96 / $755.34 / $1,160.19
| Professional | | $508.96 | $755.34 | $1,160.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $409.48 / $680.31 / $1,138.76
| Facility | | $409.48 | $680.31 | $1,138.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $517.14 / $787.06 / $1,046.14
| Professional | | $517.14 | $787.06 | $1,046.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $496.00 / $825.32 / $1,009.69
| Facility | | $496.00 | $825.32 | $1,009.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $405.81 / $722.74 / $1,736.31
| Facility | | $405.81 | $722.74 | $1,736.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $576.84 / $847.91 / $1,262.10
| Professional | | $576.84 | $847.91 | $1,262.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $966.59 / $1,714.91 / $2,351.11
| Facility | | $966.59 | $1,714.91 | $2,351.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $614.38 / $924.39 / $1,424.09
| Professional | | $614.38 | $924.39 | $1,424.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,106.00 / $2,385.00 / $7,480.00
| Facility | | $1,106.00 | $2,385.00 | $7,480.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $660.35 / $955.40 / $1,438.72
| Professional | | $660.35 | $955.40 | $1,438.72 |