- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $693.18 / $5,087.00 / $8,294.00
| Facility | | $693.18 | $5,087.00 | $8,294.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $484.24 / $654.37 / $867.25
| Professional | | $484.24 | $654.37 | $867.25 |
- 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
- $580.54 / $742.38 / $1,227.36
| Professional | | $580.54 | $742.38 | $1,227.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $651.82 / $710.20 / $1,237.54
| Professional | | $651.82 | $710.20 | $1,237.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $640.00 / $640.00 / $709.38
| Facility | | $640.00 | $640.00 | $709.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $600.97 / $835.04 / $1,351.18
| Professional | | $600.97 | $835.04 | $1,351.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $599.45 / $768.69 / $908.45
| Professional | | $599.45 | $768.69 | $908.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $629.42 / $800.46 / $1,216.67
| Facility | | $629.42 | $800.46 | $1,216.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $656.00 / $867.24 / $1,174.00
| Professional | | $656.00 | $867.24 | $1,174.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $601.08 / $802.06 / $2,684.98
| Facility | | $601.08 | $802.06 | $2,684.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $601.08 / $802.06 / $2,684.98
| Professional | | $601.08 | $802.06 | $2,684.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,398.00 / $10,439.00 / $21,639.00
| Facility | | $6,398.00 | $10,439.00 | $21,639.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $497.81 / $792.20 / $1,350.46
| Professional | | $497.81 | $792.20 | $1,350.46 |