- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $938.83 / $5,412.00 / $11,024.00
| Facility | | $938.83 | $5,412.00 | $11,024.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $705.15 / $898.14 / $1,121.72
| Professional | | $705.15 | $898.14 | $1,121.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,525.00 / $11,065.00 / $12,418.00
| Facility | | $8,525.00 | $11,065.00 | $12,418.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $732.00 / $947.13 / $1,338.86
| Professional | | $732.00 | $947.13 | $1,338.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $810.02 / $852.51 / $1,628.14
| Professional | | $810.02 | $852.51 | $1,628.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $490.00 / $610.00 / $925.00
| Facility | | $490.00 | $610.00 | $925.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $671.97 / $957.79 / $1,785.76
| Professional | | $671.97 | $957.79 | $1,785.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $745.82 / $921.31 / $1,282.54
| Professional | | $745.82 | $921.31 | $1,282.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $798.01 / $995.16 / $1,467.23
| Facility | | $798.01 | $995.16 | $1,467.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $916.00 / $1,114.00 / $1,853.66
| Professional | | $916.00 | $1,114.00 | $1,853.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $759.92 / $965.85 / $1,874.64
| Facility | | $759.92 | $965.85 | $1,874.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $759.92 / $965.85 / $1,874.64
| Professional | | $759.92 | $965.85 | $1,874.64 |
- 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
- $615.54 / $903.00 / $1,487.48
| Professional | | $615.54 | $903.00 | $1,487.48 |