- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $696.89 / $3,839.00 / $8,240.00
| Facility | | $696.89 | $3,839.00 | $8,240.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $498.19 / $621.51 / $859.64
| Professional | | $498.19 | $621.51 | $859.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,431.95 / $7,827.00 / $19,139.18
| Facility | | $6,431.95 | $7,827.00 | $19,139.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $660.19 / $943.82 / $1,357.44
| Professional | | $660.19 | $943.82 | $1,357.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $594.24 / $855.94 / $1,440.73
| Professional | | $594.24 | $855.94 | $1,440.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $902.82 / $1,200.70 / $1,204.30
| Professional | | $902.82 | $1,200.70 | $1,204.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,996.18 / $4,622.95 / $9,148.60
| Facility | | $2,996.18 | $4,622.95 | $9,148.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $976.00 / $4,597.00 / $8,247.00
| Facility | | $976.00 | $4,597.00 | $8,247.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $513.36 / $655.40 / $2,022.01
| Professional | | $513.36 | $655.40 | $2,022.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $799.47 / $944.14 / $1,549.50
| Professional | | $799.47 | $944.14 | $1,549.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $602.50 / $864.77 / $1,454.13
| Professional | | $602.50 | $864.77 | $1,454.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $547.46 / $602.85 / $737.99
| Facility | | $547.46 | $602.85 | $737.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $585.09 / $717.60 / $785.48
| Professional | | $585.09 | $717.60 | $785.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,155.00 / $3,475.00 / $6,000.00
| Facility | | $2,155.00 | $3,475.00 | $6,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $642.98 / $901.44 / $1,493.50
| Professional | | $642.98 | $901.44 | $1,493.50 |