- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $945.75 / $2,663.12 / $4,712.00
| Facility | | $945.75 | $2,663.12 | $4,712.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $277.17 / $945.75 / $2,125.33
| Professional | | $277.17 | $945.75 | $2,125.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $746.51 / $5,268.00 / $26,542.00
| Facility | | $746.51 | $5,268.00 | $26,542.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $333.21 / $1,966.24 / $6,053.41
| Professional | | $333.21 | $1,966.24 | $6,053.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $356.64 / $463.63 / $909.43
| Facility | | $356.64 | $463.63 | $909.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $513.20 / $1,358.80 / $2,643.39
| Professional | | $513.20 | $1,358.80 | $2,643.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $552.87 / $1,617.24 / $3,938.57
| Professional | | $552.87 | $1,617.24 | $3,938.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $303.70 / $650.29 / $6,679.00
| Facility | | $303.70 | $650.29 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,483.66 / $1,748.15 / $3,125.57
| Professional | | $1,483.66 | $1,748.15 | $3,125.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $381.75 / $1,458.18 / $3,631.74
| Professional | | $381.75 | $1,458.18 | $3,631.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,368.87 / $2,368.87 / $2,368.87
| Facility | | $2,368.87 | $2,368.87 | $2,368.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $451.33 / $451.33 / $486.21
| Professional | | $451.33 | $451.33 | $486.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,006.55 / $5,572.00 / $26,542.00
| Facility | | $2,006.55 | $5,572.00 | $26,542.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,864.37 / $3,283.47 / $9,186.28
| Professional | | $1,864.37 | $3,283.47 | $9,186.28 |
- 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
- $1,556.59 / $2,074.41 / $3,800.44
| Professional | | $1,556.59 | $2,074.41 | $3,800.44 |