- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $920.90 / $4,196.00 / $9,347.59
| Facility | | $920.90 | $4,196.00 | $9,347.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $657.49 / $819.94 / $1,034.36
| Professional | | $657.49 | $819.94 | $1,034.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,153.00 / $7,363.00 / $9,410.00
| Facility | | $6,153.00 | $7,363.00 | $9,410.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $668.85 / $891.85 / $1,329.20
| Professional | | $668.85 | $891.85 | $1,329.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $718.93 / $722.99 / $1,453.21
| Professional | | $718.93 | $722.99 | $1,453.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $605.00 / $1,137.56 / $3,282.37
| Facility | | $605.00 | $1,137.56 | $3,282.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $666.84 / $962.82 / $1,633.37
| Professional | | $666.84 | $962.82 | $1,633.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $761.36 / $999.29 / $1,421.16
| Professional | | $761.36 | $999.29 | $1,421.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $742.28 / $1,005.17 / $1,504.41
| Facility | | $742.28 | $1,005.17 | $1,504.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,003.00 / $1,184.00 / $1,610.00
| Professional | | $1,003.00 | $1,184.00 | $1,610.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $677.28 / $858.27 / $1,545.59
| Facility | | $677.28 | $858.27 | $1,545.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $823.80 / $1,041.83 / $1,974.43
| Professional | | $823.80 | $1,041.83 | $1,974.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $908.00 / $5,815.00 / $12,680.00
| Facility | | $908.00 | $5,815.00 | $12,680.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $643.11 / $986.10 / $1,624.13
| Professional | | $643.11 | $986.10 | $1,624.13 |