- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $794.17 / $4,771.00 / $9,539.00
| Facility | | $794.17 | $4,771.00 | $9,539.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $483.43 / $794.17 / $1,131.31
| Professional | | $483.43 | $794.17 | $1,131.31 |
- 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
- $679.17 / $864.22 / $1,206.27
| Professional | | $679.17 | $864.22 | $1,206.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $702.90 / $948.92 / $4,284.00
| Professional | | $702.90 | $948.92 | $4,284.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $533.36 / $773.40 / $1,620.38
| Professional | | $533.36 | $773.40 | $1,620.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $695.35 / $834.42 / $1,034.25
| Professional | | $695.35 | $834.42 | $1,034.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $707.70 / $937.99 / $1,342.15
| Facility | | $707.70 | $937.99 | $1,342.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $651.00 / $766.00 / $1,430.00
| Professional | | $651.00 | $766.00 | $1,430.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $555.61 / $842.23 / $7,420.00
| Facility | | $555.61 | $842.23 | $7,420.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $555.61 / $842.23 / $7,420.00
| Professional | | $555.61 | $842.23 | $7,420.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,303.00 / $9,373.00 / $17,192.00
| Facility | | $6,303.00 | $9,373.00 | $17,192.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $510.25 / $730.41 / $1,470.81
| Professional | | $510.25 | $730.41 | $1,470.81 |