- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $457.96 / $1,591.37 / $2,733.09
| Facility | | $457.96 | $1,591.37 | $2,733.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $457.96 / $660.27 / $1,970.87
| Professional | | $457.96 | $660.27 | $1,970.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $716.02 / $1,507.11 / $4,757.28
| Facility | | $716.02 | $1,507.11 | $4,757.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $561.54 / $861.08 / $12,463.23
| Professional | | $561.54 | $861.08 | $12,463.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,181.97 / $1,870.03 / $3,152.28
| Facility | | $1,181.97 | $1,870.03 | $3,152.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $751.28 / $1,255.99 / $1,668.97
| Professional | | $751.28 | $1,255.99 | $1,668.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $49,922.00 / $52,419.00 / $56,064.00
| Facility | | $49,922.00 | $52,419.00 | $56,064.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $721.24 / $1,219.45 / $2,022.44
| Professional | | $721.24 | $1,219.45 | $2,022.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $655.94 / $1,369.88 / $6,679.00
| Facility | | $655.94 | $1,369.88 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $737.93 / $932.47 / $1,387.96
| Professional | | $737.93 | $932.47 | $1,387.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $797.08 / $1,472.21 / $2,031.76
| Professional | | $797.08 | $1,472.21 | $2,031.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,003.98 / $1,906.19 / $2,685.00
| Professional | | $1,003.98 | $1,906.19 | $2,685.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,757.28 / $4,757.28 / $5,947.12
| Facility | | $4,757.28 | $4,757.28 | $5,947.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $638.64 / $950.00 / $12,463.23
| Professional | | $638.64 | $950.00 | $12,463.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $634.44 / $861.08 / $1,756.03
| Professional | | $634.44 | $861.08 | $1,756.03 |