- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $744.73 / $1,245.00 / $7,278.00
| Facility | | $744.73 | $1,245.00 | $7,278.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $718.04 / $770.33 / $1,281.09
| Professional | | $718.04 | $770.33 | $1,281.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,506.47 / $1,657.11 / $2,812.07
| Facility | | $1,506.47 | $1,657.11 | $2,812.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $728.87 / $1,301.00 / $2,063.50
| Professional | | $728.87 | $1,301.00 | $2,063.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $498.00 / $764.91 / $1,274.22
| Facility | | $498.00 | $764.91 | $1,274.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $712.95 / $1,100.39 / $1,895.22
| Professional | | $712.95 | $1,100.39 | $1,895.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $677.00 / $880.00 / $1,355.26
| Facility | | $677.00 | $880.00 | $1,355.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $508.00 / $568.00 / $1,107.11
| Professional | | $508.00 | $568.00 | $1,107.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $608.79 / $727.00 / $1,726.00
| Professional | | $608.79 | $727.00 | $1,726.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $393.00 / $650.00 / $4,824.00
| Facility | | $393.00 | $650.00 | $4,824.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $643.99 / $883.86 / $1,825.67
| Professional | | $643.99 | $883.86 | $1,825.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,170.06 / $5,185.32 / $16,394.00
| Facility | | $4,170.06 | $5,185.32 | $16,394.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,458.40 / $5,458.40 / $6,376.95
| Professional | | $5,458.40 | $5,458.40 | $6,376.95 |