- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $588.84 / $912.01 / $13,182.57
| Facility | | $588.84 | $912.01 | $13,182.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $263.03 / $457.09 / $1,023.29
| Professional | | $263.03 | $457.09 | $1,023.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $478.63 / $758.58 / $1,318.26
| Professional | | $478.63 | $758.58 | $1,318.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $478.63 / $691.83 / $1,174.90
| Professional | | $478.63 | $691.83 | $1,174.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $389.05 / $691.83 / $1,288.25
| Facility | | $389.05 | $691.83 | $1,288.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $478.63 / $794.33 / $1,122.02
| Professional | | $478.63 | $794.33 | $1,122.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $645.65 / $954.99 / $1,000.00
| Facility | | $645.65 | $954.99 | $1,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $380.19 / $660.69 / $1,174.90
| Facility | | $380.19 | $660.69 | $1,174.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $79.43 / $776.25 / $1,230.27
| Professional | | $79.43 | $776.25 | $1,230.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,412.54 / $1,995.26 / $2,398.83
| Facility | | $1,412.54 | $1,995.26 | $2,398.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $645.65 / $912.01 / $1,288.25
| Professional | | $645.65 | $912.01 | $1,288.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $389.05 / $3,311.31 / $6,165.95
| Facility | | $389.05 | $3,311.31 | $6,165.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $467.74 / $776.25 / $1,258.93
| Professional | | $467.74 | $776.25 | $1,258.93 |