- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $728.07 / $7,920.26 / $18,504.31
| Facility | | $728.07 | $7,920.26 | $18,504.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $326.68 / $434.05 / $1,470.00
| Professional | | $326.68 | $434.05 | $1,470.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $492.01 / $816.31 / $1,106.30
| Professional | | $492.01 | $816.31 | $1,106.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $594.15 / $852.46 / $959.79
| Professional | | $594.15 | $852.46 | $959.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $434.05 / $723.34 / $1,016.31
| Facility | | $434.05 | $723.34 | $1,016.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $559.47 / $636.24 / $1,190.41
| Professional | | $559.47 | $636.24 | $1,190.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $501.36 / $689.06 / $753.75
| Facility | | $501.36 | $689.06 | $753.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $434.05 / $878.90 / $5,626.00
| Facility | | $434.05 | $878.90 | $5,626.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $636.07 / $865.02 / $1,106.30
| Professional | | $636.07 | $865.02 | $1,106.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,624.30 / $17,810.43 / $21,600.03
| Facility | | $13,624.30 | $17,810.43 | $21,600.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $687.60 / $923.06 / $1,180.13
| Professional | | $687.60 | $923.06 | $1,180.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,028.00 / $18,628.00 / $26,255.00
| Facility | | $3,028.00 | $18,628.00 | $26,255.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $555.88 / $748.31 / $1,189.44
| Professional | | $555.88 | $748.31 | $1,189.44 |