- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,088.00 / $3,645.00 / $8,294.00
| Facility | | $1,088.00 | $3,645.00 | $8,294.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $579.23 / $670.39 / $1,146.40
| Professional | | $579.23 | $670.39 | $1,146.40 |
- 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
- $595.28 / $761.24 / $1,258.55
| Professional | | $595.28 | $761.24 | $1,258.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $690.83 / $727.12 / $7,889.00
| Professional | | $690.83 | $727.12 | $7,889.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $572.00 / $572.00 / $726.86
| Facility | | $572.00 | $572.00 | $726.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $623.90 / $838.66 / $1,389.83
| Professional | | $623.90 | $838.66 | $1,389.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $614.00 / $786.38 / $929.36
| Professional | | $614.00 | $786.38 | $929.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $664.87 / $840.00 / $1,226.81
| Facility | | $664.87 | $840.00 | $1,226.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $786.00 / $891.70 / $1,230.00
| Professional | | $786.00 | $891.70 | $1,230.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $616.10 / $802.32 / $2,704.91
| Facility | | $616.10 | $802.32 | $2,704.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $616.10 / $802.32 / $2,704.91
| Professional | | $616.10 | $802.32 | $2,704.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,651.00 / $6,870.00 / $12,739.00
| Facility | | $3,651.00 | $6,870.00 | $12,739.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $499.79 / $782.27 / $1,221.93
| Professional | | $499.79 | $782.27 | $1,221.93 |