- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $694.57 / $4,796.00 / $9,539.00
| Facility | | $694.57 | $4,796.00 | $9,539.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $610.54 / $694.57 / $841.93
| Professional | | $610.54 | $694.57 | $841.93 |
- 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
- $604.49 / $805.02 / $1,165.49
| Professional | | $604.49 | $805.02 | $1,165.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $644.92 / $829.20 / $4,284.00
| Professional | | $644.92 | $829.20 | $4,284.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $627.98 / $886.37 / $1,686.95
| Professional | | $627.98 | $886.37 | $1,686.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $721.65 / $865.98 / $1,068.04
| Professional | | $721.65 | $865.98 | $1,068.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $685.68 / $882.45 / $1,334.38
| Facility | | $685.68 | $882.45 | $1,334.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $862.00 / $1,016.00 / $1,444.92
| Professional | | $862.00 | $1,016.00 | $1,444.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $583.91 / $771.50 / $5,122.00
| Facility | | $583.91 | $771.50 | $5,122.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $726.69 / $952.86 / $5,122.00
| Professional | | $726.69 | $952.86 | $5,122.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,303.00 / $9,373.00 / $17,192.00
| Facility | | $6,303.00 | $9,373.00 | $17,192.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $615.66 / $963.97 / $1,653.90
| Professional | | $615.66 | $963.97 | $1,653.90 |