- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $796.06 / $3,838.00 / $8,017.00
| Facility | | $796.06 | $3,838.00 | $8,017.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $591.45 / $746.97 / $1,002.85
| Professional | | $591.45 | $746.97 | $1,002.85 |
- 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
- $657.14 / $681.93 / $681.93
| Professional | | $657.14 | $681.93 | $681.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $634.58 / $810.64 / $1,304.51
| Professional | | $634.58 | $810.64 | $1,304.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,027.21 / $1,027.21 / $1,065.45
| Professional | | $1,027.21 | $1,027.21 | $1,065.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $954.00 / $4,068.00 / $8,247.00
| Facility | | $954.00 | $4,068.00 | $8,247.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $612.47 / $784.10 / $3,372.66
| Professional | | $612.47 | $784.10 | $3,372.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.00 / $970.10 / $1,667.40
| Professional | | $15.00 | $970.10 | $1,667.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $634.58 / $831.80 / $1,304.51
| Professional | | $634.58 | $831.80 | $1,304.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $641.17 / $641.17 / $697.76
| Facility | | $641.17 | $641.17 | $697.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $616.41 / $649.22 / $697.76
| Professional | | $616.41 | $649.22 | $697.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,304.00 / $4,584.00 / $9,631.00
| Facility | | $2,304.00 | $4,584.00 | $9,631.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $592.14 / $789.89 / $1,244.70
| Professional | | $592.14 | $789.89 | $1,244.70 |