- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $732.46 / $2,747.00 / $8,017.00
| Facility | | $732.46 | $2,747.00 | $8,017.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $569.00 / $689.98 / $894.66
| Professional | | $569.00 | $689.98 | $894.66 |
- 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
- $789.03 / $818.81 / $1,445.64
| Professional | | $789.03 | $818.81 | $1,445.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $632.71 / $794.77 / $1,412.38
| Professional | | $632.71 | $794.77 | $1,412.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $948.14 / $1,219.04 / $1,261.52
| Professional | | $948.14 | $1,219.04 | $1,261.52 |
- 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
- $618.44 / $732.46 / $3,860.40
| Professional | | $618.44 | $732.46 | $3,860.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,231.81 / $1,231.81 / $1,231.81
| Facility | | $1,231.81 | $1,231.81 | $1,231.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $641.37 / $803.98 / $1,454.31
| Professional | | $641.37 | $803.98 | $1,454.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $608.63 / $710.58 / $776.03
| Facility | | $608.63 | $710.58 | $776.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $659.29 / $752.88 / $824.92
| Professional | | $659.29 | $752.88 | $824.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,440.00 / $3,475.00 / $6,368.00
| Facility | | $1,440.00 | $3,475.00 | $6,368.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $628.38 / $858.30 / $1,506.28
| Professional | | $628.38 | $858.30 | $1,506.28 |