- 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
- $685.47 / $840.27 / $1,086.00
| Professional | | $685.47 | $840.27 | $1,086.00 |
- 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
- $754.74 / $977.39 / $1,615.91
| Professional | | $754.74 | $977.39 | $1,615.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $774.32 / $897.02 / $3,019.00
| Professional | | $774.32 | $897.02 | $3,019.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $572.00 / $572.00 / $927.20
| Facility | | $572.00 | $572.00 | $927.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $766.23 / $973.87 / $1,765.94
| Professional | | $766.23 | $973.87 | $1,765.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $783.54 / $1,010.13 / $1,193.79
| Professional | | $783.54 | $1,010.13 | $1,193.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $783.54 / $990.16 / $1,480.86
| Facility | | $783.54 | $990.16 | $1,480.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $930.00 / $1,063.11 / $1,531.00
| Professional | | $930.00 | $1,063.11 | $1,531.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $707.39 / $992.18 / $2,039.00
| Facility | | $707.39 | $992.18 | $2,039.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $707.39 / $992.18 / $2,039.00
| Professional | | $707.39 | $992.18 | $2,039.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,713.00 / $2,863.00 / $5,340.00
| Facility | | $1,713.00 | $2,863.00 | $5,340.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $595.38 / $938.39 / $1,480.36
| Professional | | $595.38 | $938.39 | $1,480.36 |