- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $572.16 / $3,988.00 / $8,003.00
| Facility | | $572.16 | $3,988.00 | $8,003.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $330.25 / $501.12 / $776.71
| Professional | | $330.25 | $501.12 | $776.71 |
- 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
- $335.02 / $433.48 / $716.67
| Professional | | $335.02 | $433.48 | $716.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $382.05 / $411.09 / $5,113.00
| Professional | | $382.05 | $411.09 | $5,113.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $627.27 / $627.27 / $640.00
| Facility | | $627.27 | $627.27 | $640.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $376.98 / $567.79 / $1,014.05
| Professional | | $376.98 | $567.79 | $1,014.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $523.67 / $672.51 / $794.78
| Professional | | $523.67 | $672.51 | $794.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $394.96 / $606.50 / $943.00
| Facility | | $394.96 | $606.50 | $943.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $649.00 / $758.00 / $1,021.00
| Professional | | $649.00 | $758.00 | $1,021.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $353.92 / $463.41 / $1,729.80
| Facility | | $353.92 | $463.41 | $1,729.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $504.47 / $679.93 / $2,392.15
| Professional | | $504.47 | $679.93 | $2,392.15 |
- 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
- $423.66 / $620.77 / $1,034.38
| Professional | | $423.66 | $620.77 | $1,034.38 |