- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $788.18 / $12,274.80 / $21,735.00
| Facility | | $788.18 | $12,274.80 | $21,735.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $415.50 / $483.52 / $1,889.41
| Professional | | $415.50 | $483.52 | $1,889.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $482.35 / $800.11 / $1,069.92
| Professional | | $482.35 | $800.11 | $1,069.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $557.29 / $796.61 / $906.84
| Professional | | $557.29 | $796.61 | $906.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $483.52 / $769.74 / $1,039.57
| Facility | | $483.52 | $769.74 | $1,039.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $568.94 / $810.30 / $1,130.98
| Professional | | $568.94 | $810.30 | $1,130.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $513.09 / $678.87 / $852.55
| Facility | | $513.09 | $678.87 | $852.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $483.52 / $869.84 / $1,014.37
| Facility | | $483.52 | $869.84 | $1,014.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $637.96 / $860.78 / $1,115.49
| Professional | | $637.96 | $860.78 | $1,115.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $62,246.10 / $77,972.48 / $94,895.79
| Facility | | $62,246.10 | $77,972.48 | $94,895.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $666.07 / $876.26 / $1,154.26
| Professional | | $666.07 | $876.26 | $1,154.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,425.00 / $64,404.00 / $94,117.00
| Facility | | $7,425.00 | $64,404.00 | $94,117.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $561.27 / $797.15 / $1,152.21
| Professional | | $561.27 | $797.15 | $1,152.21 |