- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $924.24 / $1,479.17 / $8,413.00
| Facility | | $924.24 | $1,479.17 | $8,413.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $897.00 / $972.34 / $1,722.64
| Professional | | $897.00 | $972.34 | $1,722.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.08 / $575.08 / $583.47
| Facility | | $575.08 | $575.08 | $583.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $834.97 / $1,346.85 / $2,055.06
| Professional | | $834.97 | $1,346.85 | $2,055.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $606.10 / $606.10 / $820.28
| Facility | | $606.10 | $606.10 | $820.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $825.03 / $1,202.44 / $2,243.09
| Professional | | $825.03 | $1,202.44 | $2,243.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $897.00 / $957.03 / $1,655.90
| Facility | | $897.00 | $957.03 | $1,655.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $579.00 / $1,192.00 / $1,221.00
| Professional | | $579.00 | $1,192.00 | $1,221.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.00 / $1,426.06 / $2,146.80
| Professional | | $6.00 | $1,426.06 | $2,146.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $677.92 / $2,376.00 / $3,517.00
| Facility | | $677.92 | $2,376.00 | $3,517.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $760.58 / $1,082.43 / $2,357.21
| Professional | | $760.58 | $1,082.43 | $2,357.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,396.81 / $7,596.26 / $26,542.00
| Facility | | $6,396.81 | $7,596.26 | $26,542.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,677.28 / $6,677.28 / $8,633.93
| Professional | | $6,677.28 | $6,677.28 | $8,633.93 |