- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $771.49 / $2,671.00 / $5,454.00
| Facility | | $771.49 | $2,671.00 | $5,454.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $240.47 / $771.49 / $3,095.70
| Professional | | $240.47 | $771.49 | $3,095.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $888.13 / $5,268.00 / $26,542.00
| Facility | | $888.13 | $5,268.00 | $26,542.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $410.23 / $1,853.61 / $6,080.47
| Professional | | $410.23 | $1,853.61 | $6,080.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $440.64 / $572.83 / $1,123.63
| Facility | | $440.64 | $572.83 | $1,123.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $602.79 / $1,452.25 / $2,606.64
| Professional | | $602.79 | $1,452.25 | $2,606.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $670.87 / $1,983.21 / $4,073.94
| Professional | | $670.87 | $1,983.21 | $4,073.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $374.51 / $803.46 / $6,679.00
| Facility | | $374.51 | $803.46 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,463.03 / $1,728.40 / $3,090.26
| Professional | | $1,463.03 | $1,728.40 | $3,090.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $473.09 / $1,448.76 / $3,608.28
| Professional | | $473.09 | $1,448.76 | $3,608.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,050.05 / $3,050.05 / $3,103.34
| Facility | | $3,050.05 | $3,050.05 | $3,103.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $600.91 / $601.03 / $616.28
| Professional | | $600.91 | $601.03 | $616.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,155.00 / $5,572.00 / $26,542.00
| Facility | | $2,155.00 | $5,572.00 | $26,542.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,745.01 / $3,230.95 / $8,385.52
| Professional | | $1,745.01 | $3,230.95 | $8,385.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,155.00 / $4,983.00 / $8,810.00
| Facility | | $2,155.00 | $4,983.00 | $8,810.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,584.22 / $2,288.31 / $5,795.96
| Professional | | $1,584.22 | $2,288.31 | $5,795.96 |