- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $921.70 / $3,645.00 / $8,294.00
| Facility | | $921.70 | $3,645.00 | $8,294.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $520.03 / $554.98 / $751.22
| Professional | | $520.03 | $554.98 | $751.22 |
- 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
- $493.87 / $631.54 / $1,044.14
| Professional | | $493.87 | $631.54 | $1,044.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $581.88 / $602.05 / $1,134.67
| Professional | | $581.88 | $602.05 | $1,134.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $572.00 / $572.00 / $602.99
| Facility | | $572.00 | $572.00 | $602.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $523.05 / $778.75 / $1,312.65
| Professional | | $523.05 | $778.75 | $1,312.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $509.09 / $651.64 / $769.50
| Professional | | $509.09 | $651.64 | $769.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $517.08 / $733.77 / $1,346.04
| Facility | | $517.08 | $733.77 | $1,346.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $687.00 / $792.51 / $1,245.98
| Professional | | $687.00 | $792.51 | $1,245.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $538.94 / $772.03 / $2,491.23
| Facility | | $538.94 | $772.03 | $2,491.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $538.94 / $772.03 / $2,491.23
| Professional | | $538.94 | $772.03 | $2,491.23 |
- 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
- $441.45 / $766.73 / $1,272.20
| Professional | | $441.45 | $766.73 | $1,272.20 |