- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $961.13 / $5,040.00 / $10,637.11
| Facility | | $961.13 | $5,040.00 | $10,637.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $482.04 / $582.64 / $843.83
| Professional | | $482.04 | $582.64 | $843.83 |
- 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
- $510.88 / $661.03 / $1,092.88
| Professional | | $510.88 | $661.03 | $1,092.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $596.62 / $634.22 / $3,714.00
| Professional | | $596.62 | $634.22 | $3,714.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $632.01 / $632.01 / $900.00
| Facility | | $632.01 | $632.01 | $900.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $521.07 / $675.55 / $1,193.58
| Professional | | $521.07 | $675.55 | $1,193.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $534.42 / $686.84 / $811.72
| Professional | | $534.42 | $686.84 | $811.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $534.42 / $694.72 / $1,029.98
| Facility | | $534.42 | $694.72 | $1,029.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $655.00 / $752.00 / $1,062.00
| Professional | | $655.00 | $752.00 | $1,062.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $525.54 / $692.98 / $2,373.16
| Facility | | $525.54 | $692.98 | $2,373.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $525.54 / $692.98 / $2,373.16
| Professional | | $525.54 | $692.98 | $2,373.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,121.00 / $8,621.00 / $17,192.00
| Facility | | $5,121.00 | $8,621.00 | $17,192.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $411.67 / $651.89 / $1,020.19
| Professional | | $411.67 | $651.89 | $1,020.19 |