- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,042.60 / $5,360.00 / $9,975.00
| Facility | | $1,042.60 | $5,360.00 | $9,975.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $627.27 / $806.86 / $1,065.58
| Professional | | $627.27 | $806.86 | $1,065.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,032.00 / $6,548.00 / $7,221.00
| Facility | | $5,032.00 | $6,548.00 | $7,221.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $729.66 / $937.21 / $1,324.46
| Professional | | $729.66 | $937.21 | $1,324.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $807.23 / $1,574.10 / $8,031.00
| Professional | | $807.23 | $1,574.10 | $8,031.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $904.84 / $904.84 / $904.84
| Facility | | $904.84 | $904.84 | $904.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $687.93 / $911.71 / $1,472.77
| Professional | | $687.93 | $911.71 | $1,472.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $754.55 / $887.71 / $1,138.19
| Professional | | $754.55 | $887.71 | $1,138.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $696.68 / $928.49 / $1,458.74
| Facility | | $696.68 | $928.49 | $1,458.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $920.00 / $1,053.00 / $1,535.28
| Professional | | $920.00 | $1,053.00 | $1,535.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $673.16 / $948.62 / $9,210.00
| Facility | | $673.16 | $948.62 | $9,210.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $673.16 / $948.62 / $9,210.00
| Professional | | $673.16 | $948.62 | $9,210.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,303.00 / $9,270.00 / $17,192.00
| Facility | | $6,303.00 | $9,270.00 | $17,192.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $547.90 / $733.90 / $1,346.76
| Professional | | $547.90 | $733.90 | $1,346.76 |