- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,244.00 / $5,048.00 / $8,294.00
| Facility | | $1,244.00 | $5,048.00 | $8,294.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $653.10 / $757.95 / $1,013.06
| Professional | | $653.10 | $757.95 | $1,013.06 |
- 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
- $673.34 / $861.06 / $1,423.59
| Professional | | $673.34 | $861.06 | $1,423.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $717.73 / $821.97 / $6,433.00
| Professional | | $717.73 | $821.97 | $6,433.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $640.00 / $640.00 / $821.71
| Facility | | $640.00 | $640.00 | $821.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $711.45 / $1,015.54 / $1,575.11
| Professional | | $711.45 | $1,015.54 | $1,575.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $694.10 / $888.47 / $1,050.01
| Professional | | $694.10 | $888.47 | $1,050.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $742.04 / $956.27 / $1,479.43
| Facility | | $742.04 | $956.27 | $1,479.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $894.00 / $1,046.33 / $1,364.00
| Professional | | $894.00 | $1,046.33 | $1,364.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $696.63 / $961.30 / $3,130.22
| Facility | | $696.63 | $961.30 | $3,130.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $696.63 / $961.30 / $3,130.22
| Professional | | $696.63 | $961.30 | $3,130.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,423.00 / $11,475.00 / $21,639.00
| Facility | | $6,423.00 | $11,475.00 | $21,639.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $588.05 / $923.49 / $1,459.34
| Professional | | $588.05 | $923.49 | $1,459.34 |