- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $737.79 / $2,747.00 / $8,017.00
| Facility | | $737.79 | $2,747.00 | $8,017.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $599.54 / $701.06 / $999.13
| Professional | | $599.54 | $701.06 | $999.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,299.82 / $2,746.00 / $13,822.74
| Facility | | $2,299.82 | $2,746.00 | $13,822.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $806.83 / $837.28 / $1,423.83
| Professional | | $806.83 | $837.28 | $1,423.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $638.61 / $833.06 / $1,450.05
| Professional | | $638.61 | $833.06 | $1,450.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $960.34 / $1,234.72 / $1,274.82
| Professional | | $960.34 | $1,234.72 | $1,274.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $918.00 / $3,120.00 / $8,017.00
| Facility | | $918.00 | $3,120.00 | $8,017.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $606.36 / $750.41 / $3,588.44
| Professional | | $606.36 | $750.41 | $3,588.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $962.60 / $962.60 / $1,096.30
| Professional | | $962.60 | $962.60 | $1,096.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,191.29 / $1,191.29 / $1,191.29
| Facility | | $1,191.29 | $1,191.29 | $1,191.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $663.16 / $843.77 / $1,571.00
| Professional | | $663.16 | $843.77 | $1,571.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $656.29 / $673.47 / $782.55
| Facility | | $656.29 | $673.47 | $782.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $656.29 / $739.46 / $828.50
| Professional | | $656.29 | $739.46 | $828.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $637.00 / $1,734.00 / $4,300.00
| Facility | | $637.00 | $1,734.00 | $4,300.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $700.65 / $879.19 / $1,524.29
| Professional | | $700.65 | $879.19 | $1,524.29 |