- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $788.54 / $3,645.00 / $8,294.00
| Facility | | $788.54 | $3,645.00 | $8,294.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $593.67 / $697.02 / $900.87
| Professional | | $593.67 | $697.02 | $900.87 |
- 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
- $615.78 / $795.04 / $1,123.85
| Professional | | $615.78 | $795.04 | $1,123.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $668.15 / $716.09 / $1,336.30
| Professional | | $668.15 | $716.09 | $1,336.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $425.00 / $763.69 / $1,896.02
| Facility | | $425.00 | $763.69 | $1,896.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $578.10 / $804.00 / $1,440.91
| Professional | | $578.10 | $804.00 | $1,440.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $589.70 / $760.98 / $1,054.54
| Professional | | $589.70 | $760.98 | $1,054.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $670.26 / $838.91 / $1,275.55
| Facility | | $670.26 | $838.91 | $1,275.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $763.00 / $881.00 / $1,498.00
| Professional | | $763.00 | $881.00 | $1,498.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $645.60 / $794.62 / $1,573.89
| Facility | | $645.60 | $794.62 | $1,573.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $645.60 / $794.62 / $1,573.89
| Professional | | $645.60 | $794.62 | $1,573.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,236.00 / $8,246.00 / $17,187.00
| Facility | | $1,236.00 | $8,246.00 | $17,187.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $518.17 / $769.45 / $1,238.75
| Professional | | $518.17 | $769.45 | $1,238.75 |