- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $640.11 / $5,087.00 / $8,294.00
| Facility | | $640.11 | $5,087.00 | $8,294.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $508.07 / $610.83 / $887.81
| Professional | | $508.07 | $610.83 | $887.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,823.00 / $12,004.00 / $15,528.00
| Facility | | $9,823.00 | $12,004.00 | $15,528.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $534.57 / $691.68 / $1,143.55
| Professional | | $534.57 | $691.68 | $1,143.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $626.40 / $661.84 / $9,951.00
| Professional | | $626.40 | $661.84 | $9,951.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $640.00 / $640.00 / $661.02
| Facility | | $640.00 | $640.00 | $661.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $560.12 / $729.89 / $1,257.17
| Professional | | $560.12 | $729.89 | $1,257.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $558.54 / $716.43 / $846.69
| Professional | | $558.54 | $716.43 | $846.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $596.67 / $756.78 / $1,117.82
| Facility | | $596.67 | $756.78 | $1,117.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $709.00 / $793.00 / $1,115.00
| Professional | | $709.00 | $793.00 | $1,115.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $558.54 / $723.30 / $2,697.32
| Facility | | $558.54 | $723.30 | $2,697.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $558.54 / $723.30 / $2,697.32
| Professional | | $558.54 | $723.30 | $2,697.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,408.00 / $13,296.00 / $26,537.00
| Facility | | $7,408.00 | $13,296.00 | $26,537.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $440.77 / $698.19 / $1,111.58
| Professional | | $440.77 | $698.19 | $1,111.58 |