- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,023.41 / $7,710.00 / $11,735.00
| Facility | | $1,023.41 | $7,710.00 | $11,735.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $652.42 / $710.46 / $1,271.72
| Professional | | $652.42 | $710.46 | $1,271.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,755.00 / $3,967.00 / $19,117.00
| Facility | | $1,755.00 | $3,967.00 | $19,117.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $597.15 / $792.45 / $1,296.09
| Professional | | $597.15 | $792.45 | $1,296.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $660.01 / $792.01 / $980.28
| Facility | | $660.01 | $792.01 | $980.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $667.77 / $726.01 / $858.01
| Professional | | $667.77 | $726.01 | $858.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $792.33 / $4,048.28 / $5,935.99
| Facility | | $792.33 | $4,048.28 | $5,935.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $609.88 / $917.97 / $1,412.43
| Professional | | $609.88 | $917.97 | $1,412.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $792.33 / $4,048.28 / $4,422.06
| Facility | | $792.33 | $4,048.28 | $4,422.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $656.23 / $926.81 / $1,373.41
| Professional | | $656.23 | $926.81 | $1,373.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $72.25 / $650.60 / $974.14
| Professional | | $72.25 | $650.60 | $974.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,050.00 / $6,227.00 / $9,483.00
| Facility | | $1,050.00 | $6,227.00 | $9,483.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $596.49 / $844.91 / $1,473.75
| Professional | | $596.49 | $844.91 | $1,473.75 |