- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $653.11 / $5,087.00 / $8,294.00
| Facility | | $653.11 | $5,087.00 | $8,294.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $515.66 / $612.69 / $821.21
| Professional | | $515.66 | $612.69 | $821.21 |
- 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
- $538.22 / $696.40 / $1,151.34
| Professional | | $538.22 | $696.40 | $1,151.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $636.59 / $665.14 / $3,019.00
| Professional | | $636.59 | $665.14 | $3,019.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $640.00 / $640.00 / $665.11
| Facility | | $640.00 | $640.00 | $665.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $562.57 / $731.37 / $1,274.38
| Professional | | $562.57 | $731.37 | $1,274.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $561.86 / $719.57 / $850.40
| Professional | | $561.86 | $719.57 | $850.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $593.11 / $754.00 / $1,099.50
| Facility | | $593.11 | $754.00 | $1,099.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $710.00 / $803.73 / $1,133.00
| Professional | | $710.00 | $803.73 | $1,133.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $561.87 / $730.43 / $2,532.31
| Facility | | $561.87 | $730.43 | $2,532.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $561.87 / $730.43 / $2,532.31
| Professional | | $561.87 | $730.43 | $2,532.31 |
- 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
- $448.27 / $700.11 / $1,120.56
| Professional | | $448.27 | $700.11 | $1,120.56 |