- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $752.75 / $2,670.00 / $6,235.00
| Facility | | $752.75 | $2,670.00 | $6,235.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $341.60 / $537.55 / $1,257.83
| Professional | | $341.60 | $537.55 | $1,257.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $983.04 / $3,764.00 / $12,379.00
| Facility | | $983.04 | $3,764.00 | $12,379.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $441.84 / $992.92 / $3,777.68
| Professional | | $441.84 | $992.92 | $3,777.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $486.41 / $631.36 / $1,115.82
| Facility | | $486.41 | $631.36 | $1,115.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $623.16 / $880.21 / $1,294.11
| Professional | | $623.16 | $880.21 | $1,294.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $671.83 / $1,021.93 / $2,023.63
| Professional | | $671.83 | $1,021.93 | $2,023.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $413.58 / $886.90 / $6,679.00
| Facility | | $413.58 | $886.90 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $601.39 / $759.93 / $1,287.59
| Professional | | $601.39 | $759.93 | $1,287.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $531.09 / $1,123.27 / $1,443.15
| Professional | | $531.09 | $1,123.27 | $1,443.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,647.40 / $3,394.78 / $5,770.30
| Facility | | $2,647.40 | $3,394.78 | $5,770.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $321.77 / $531.21 / $1,300.40
| Professional | | $321.77 | $531.21 | $1,300.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,902.00 / $4,249.00 / $16,394.00
| Facility | | $1,902.00 | $4,249.00 | $16,394.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $669.24 / $1,531.40 / $3,777.68
| Professional | | $669.24 | $1,531.40 | $3,777.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,902.00 / $3,764.00 / $8,766.00
| Facility | | $1,902.00 | $3,764.00 | $8,766.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $554.14 / $796.19 / $1,642.34
| Professional | | $554.14 | $796.19 | $1,642.34 |