- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $673.92 / $2,783.00 / $7,542.00
| Facility | | $673.92 | $2,783.00 | $7,542.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $567.90 / $648.15 / $1,132.63
| Professional | | $567.90 | $648.15 | $1,132.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,174.28 / $8,853.29 / $15,732.53
| Facility | | $3,174.28 | $8,853.29 | $15,732.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $586.94 / $726.72 / $1,019.33
| Professional | | $586.94 | $726.72 | $1,019.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $80.00 / $590.92 / $598.29
| Facility | | $80.00 | $590.92 | $598.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $728.34 / $728.34 / $728.34
| Facility | | $728.34 | $728.34 | $728.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $643.41 / $858.53 / $1,298.79
| Professional | | $643.41 | $858.53 | $1,298.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,403.28 / $16,394.00 / $19,913.50
| Facility | | $2,403.28 | $16,394.00 | $19,913.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,321.36 / $5,496.96 / $5,536.58
| Professional | | $5,321.36 | $5,496.96 | $5,536.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $628.03 / $861.57 / $1,323.07
| Facility | | $628.03 | $861.57 | $1,323.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $791.68 / $950.01 / $1,178.01
| Professional | | $791.68 | $950.01 | $1,178.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $714.13 / $1,083.09 / $2,344.84
| Professional | | $714.13 | $1,083.09 | $2,344.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $628.03 / $868.49 / $1,380.26
| Facility | | $628.03 | $868.49 | $1,380.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $648.97 / $903.05 / $1,328.74
| Professional | | $648.97 | $903.05 | $1,328.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,634.00 / $4,345.00 / $10,600.00
| Facility | | $1,634.00 | $4,345.00 | $10,600.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $510.02 / $684.93 / $1,102.57
| Professional | | $510.02 | $684.93 | $1,102.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $540.54 / $612.23 / $853.09
| Professional | | $540.54 | $612.23 | $853.09 |