- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $564.29 / $1,245.00 / $8,413.00
| Facility | | $564.29 | $1,245.00 | $8,413.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $491.91 / $589.28 / $1,057.94
| Professional | | $491.91 | $589.28 | $1,057.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $609.41 / $609.41 / $609.41
| Professional | | $609.41 | $609.41 | $609.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $615.54 / $857.73 / $1,531.49
| Professional | | $615.54 | $857.73 | $1,531.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $606.10 / $606.10 / $2,710.28
| Facility | | $606.10 | $606.10 | $2,710.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $598.54 / $791.48 / $1,436.43
| Professional | | $598.54 | $791.48 | $1,436.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $564.29 / $756.00 / $1,132.43
| Facility | | $564.29 | $756.00 | $1,132.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $579.00 / $714.00 / $762.00
| Professional | | $579.00 | $714.00 | $762.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $777.10 / $891.43 / $975.78
| Professional | | $777.10 | $891.43 | $975.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,661.00 / $7,659.00 / $10,502.00
| Facility | | $1,661.00 | $7,659.00 | $10,502.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $489.24 / $670.98 / $1,391.47
| Professional | | $489.24 | $670.98 | $1,391.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,190.28 / $8,957.00 / $26,542.00
| Facility | | $2,190.28 | $8,957.00 | $26,542.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,269.52 / $4,269.52 / $5,030.70
| Professional | | $4,269.52 | $4,269.52 | $5,030.70 |