- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $796.20 / $3,116.00 / $8,294.00
| Facility | | $796.20 | $3,116.00 | $8,294.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $563.84 / $711.22 / $1,349.98
| Professional | | $563.84 | $711.22 | $1,349.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,060.00 / $3,693.00 / $4,290.00
| Facility | | $3,060.00 | $3,693.00 | $4,290.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $582.01 / $792.61 / $1,140.27
| Professional | | $582.01 | $792.61 | $1,140.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $676.17 / $676.17 / $3,774.00
| Professional | | $676.17 | $676.17 | $3,774.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,024.71 / $1,024.71 / $1,024.71
| Facility | | $1,024.71 | $1,024.71 | $1,024.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $596.50 / $809.14 / $1,447.05
| Professional | | $596.50 | $809.14 | $1,447.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $808.79 / $902.02 / $1,073.83
| Professional | | $808.79 | $902.02 | $1,073.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $578.88 / $796.20 / $1,142.50
| Facility | | $578.88 | $796.20 | $1,142.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $932.00 / $1,089.00 / $1,582.70
| Professional | | $932.00 | $1,089.00 | $1,582.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $611.59 / $791.86 / $3,123.00
| Facility | | $611.59 | $791.86 | $3,123.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $700.60 / $950.28 / $3,326.94
| Professional | | $700.60 | $950.28 | $3,326.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,629.00 / $2,819.00 / $5,764.00
| Facility | | $1,629.00 | $2,819.00 | $5,764.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $583.46 / $816.62 / $1,400.13
| Professional | | $583.46 | $816.62 | $1,400.13 |