- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $595.15 / $2,422.00 / $8,017.00
| Facility | | $595.15 | $2,422.00 | $8,017.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $497.29 / $557.98 / $713.16
| Professional | | $497.29 | $557.98 | $713.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,344.69 / $3,159.00 / $14,886.03
| Facility | | $2,344.69 | $3,159.00 | $14,886.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $492.97 / $786.57 / $1,068.24
| Professional | | $492.97 | $786.57 | $1,068.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $539.17 / $737.20 / $1,150.86
| Professional | | $539.17 | $737.20 | $1,150.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $646.71 / $855.43 / $855.43
| Professional | | $646.71 | $855.43 | $855.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $641.00 / $2,371.00 / $8,017.00
| Facility | | $641.00 | $2,371.00 | $8,017.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $497.29 / $595.15 / $2,843.00
| Professional | | $497.29 | $595.15 | $2,843.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.00 / $747.10 / $1,374.60
| Professional | | $7.00 | $747.10 | $1,374.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $562.07 / $745.06 / $1,294.04
| Professional | | $562.07 | $745.06 | $1,294.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $544.20 / $544.20 / $790.31
| Facility | | $544.20 | $544.20 | $790.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $526.49 / $548.15 / $790.31
| Professional | | $526.49 | $548.15 | $790.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $435.00 / $1,305.00 / $3,742.00
| Facility | | $435.00 | $1,305.00 | $3,742.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $550.87 / $704.27 / $1,156.05
| Professional | | $550.87 | $704.27 | $1,156.05 |