- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $914.03 / $8,878.56 / $20,400.00
| Facility | | $914.03 | $8,878.56 | $20,400.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $408.67 / $590.58 / $2,195.28
| Professional | | $408.67 | $590.58 | $2,195.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $579.87 / $900.74 / $1,226.27
| Professional | | $579.87 | $900.74 | $1,226.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $670.90 / $961.15 / $1,083.39
| Professional | | $670.90 | $961.15 | $1,083.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $590.58 / $879.43 / $1,269.75
| Facility | | $590.58 | $879.43 | $1,269.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $616.59 / $729.95 / $1,332.57
| Professional | | $616.59 | $729.95 | $1,332.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $583.34 / $781.52 / $835.49
| Facility | | $583.34 | $781.52 | $835.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $590.58 / $1,007.62 / $6,246.00
| Facility | | $590.58 | $1,007.62 | $6,246.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $732.41 / $953.22 / $1,221.49
| Professional | | $732.41 | $953.22 | $1,221.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,909.34 / $10,378.18 / $13,050.49
| Facility | | $6,909.34 | $10,378.18 | $13,050.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $755.26 / $1,023.16 / $1,308.09
| Professional | | $755.26 | $1,023.16 | $1,308.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,155.00 / $12,835.00 / $26,404.00
| Facility | | $2,155.00 | $12,835.00 | $26,404.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $610.98 / $858.97 / $1,294.30
| Professional | | $610.98 | $858.97 | $1,294.30 |