- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $891.48 / $7,920.26 / $20,400.00
| Facility | | $891.48 | $7,920.26 | $20,400.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $315.01 / $527.57 / $1,285.36
| Professional | | $315.01 | $527.57 | $1,285.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $555.50 / $887.21 / $1,445.22
| Professional | | $555.50 | $887.21 | $1,445.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $655.38 / $954.64 / $1,275.88
| Professional | | $655.38 | $954.64 | $1,275.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $496.79 / $722.79 / $1,134.28
| Facility | | $496.79 | $722.79 | $1,134.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $657.54 / $857.40 / $1,307.10
| Professional | | $657.54 | $857.40 | $1,307.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $584.41 / $928.20 / $1,096.11
| Facility | | $584.41 | $928.20 | $1,096.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $496.79 / $780.61 / $7,298.55
| Facility | | $496.79 | $780.61 | $7,298.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $695.02 / $955.71 / $1,364.21
| Professional | | $695.02 | $955.71 | $1,364.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,573.85 / $5,897.44 / $7,222.39
| Facility | | $4,573.85 | $5,897.44 | $7,222.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $751.20 / $1,052.67 / $1,540.63
| Professional | | $751.20 | $1,052.67 | $1,540.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,689.00 / $5,517.00 / $7,385.00
| Facility | | $1,689.00 | $5,517.00 | $7,385.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $710.99 / $972.17 / $1,499.75
| Professional | | $710.99 | $972.17 | $1,499.75 |