- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $604.04 / $2,747.00 / $5,039.00
| Facility | | $604.04 | $2,747.00 | $5,039.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $459.78 / $605.05 / $1,034.21
| Professional | | $459.78 | $605.05 | $1,034.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,018.62 / $2,940.42 / $9,039.00
| Facility | | $1,018.62 | $2,940.42 | $9,039.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $471.88 / $851.28 / $3,284.00
| Professional | | $471.88 | $851.28 | $3,284.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $510.11 / $663.14 / $1,170.19
| Facility | | $510.11 | $663.14 | $1,170.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $715.17 / $1,018.18 / $1,514.43
| Professional | | $715.17 | $1,018.18 | $1,514.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,346.32 / $1,346.32 / $1,346.32
| Facility | | $1,346.32 | $1,346.32 | $1,346.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $478.74 / $922.51 / $1,628.59
| Professional | | $478.74 | $922.51 | $1,628.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $428.84 / $930.14 / $6,679.00
| Facility | | $428.84 | $930.14 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $669.55 / $847.70 / $1,170.15
| Professional | | $669.55 | $847.70 | $1,170.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $525.92 / $1,140.74 / $1,928.06
| Professional | | $525.92 | $1,140.74 | $1,928.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $643.52 / $643.52 / $643.52
| Professional | | $643.52 | $643.52 | $643.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,685.00 / $3,764.00 / $26,542.00
| Facility | | $1,685.00 | $3,764.00 | $26,542.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $626.55 / $1,045.09 / $5,039.83
| Professional | | $626.55 | $1,045.09 | $5,039.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,685.00 / $3,715.00 / $8,766.00
| Facility | | $1,685.00 | $3,715.00 | $8,766.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $588.04 / $794.95 / $1,838.20
| Professional | | $588.04 | $794.95 | $1,838.20 |