- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $839.54 / $5,087.00 / $8,294.00
| Facility | | $839.54 | $5,087.00 | $8,294.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $590.14 / $732.93 / $1,048.63
| Professional | | $590.14 | $732.93 | $1,048.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18,878.00 / $24,311.00 / $26,207.00
| Facility | | $18,878.00 | $24,311.00 | $26,207.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $601.10 / $764.21 / $1,066.68
| Professional | | $601.10 | $764.21 | $1,066.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $736.82 / $931.15 / $6,694.00
| Professional | | $736.82 | $931.15 | $6,694.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $646.54 / $793.70 / $1,487.24
| Professional | | $646.54 | $793.70 | $1,487.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $620.57 / $744.68 / $918.44
| Professional | | $620.57 | $744.68 | $918.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $722.06 / $874.41 / $1,238.65
| Facility | | $722.06 | $874.41 | $1,238.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $798.00 / $899.00 / $1,523.33
| Professional | | $798.00 | $899.00 | $1,523.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $609.75 / $820.96 / $9,929.00
| Facility | | $609.75 | $820.96 | $9,929.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $609.75 / $820.96 / $9,929.00
| Professional | | $609.75 | $820.96 | $9,929.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,367.00 / $13,296.00 / $26,537.00
| Facility | | $8,367.00 | $13,296.00 | $26,537.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $563.54 / $824.14 / $1,441.09
| Professional | | $563.54 | $824.14 | $1,441.09 |