- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $821.52 / $8,952.00 / $20,400.00
| Facility | | $821.52 | $8,952.00 | $20,400.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $326.25 / $450.36 / $1,194.67
| Professional | | $326.25 | $450.36 | $1,194.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,059.63 / $2,059.63 / $5,459.71
| Facility | | $2,059.63 | $2,059.63 | $5,459.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $412.00 / $792.81 / $1,155.45
| Professional | | $412.00 | $792.81 | $1,155.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $666.57 / $875.26 / $1,082.86
| Professional | | $666.57 | $875.26 | $1,082.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $449.71 / $710.65 / $1,127.38
| Facility | | $449.71 | $710.65 | $1,127.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $584.64 / $720.04 / $1,241.67
| Professional | | $584.64 | $720.04 | $1,241.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $542.42 / $765.81 / $846.88
| Facility | | $542.42 | $765.81 | $846.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $494.76 / $823.43 / $1,456.34
| Facility | | $494.76 | $823.43 | $1,456.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $683.76 / $896.40 / $1,167.47
| Professional | | $683.76 | $896.40 | $1,167.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,763.99 / $12,680.11 / $28,321.84
| Facility | | $8,763.99 | $12,680.11 | $28,321.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $770.63 / $984.11 / $1,187.22
| Professional | | $770.63 | $984.11 | $1,187.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,895.00 / $11,770.00 / $26,404.00
| Facility | | $1,895.00 | $11,770.00 | $26,404.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $587.50 / $807.40 / $1,307.80
| Professional | | $587.50 | $807.40 | $1,307.80 |