- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $865.26 / $5,649.00 / $15,341.00
| Facility | | $865.26 | $5,649.00 | $15,341.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $396.08 / $514.16 / $2,072.17
| Professional | | $396.08 | $514.16 | $2,072.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $545.35 / $851.59 / $1,159.40
| Professional | | $545.35 | $851.59 | $1,159.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $634.75 / $909.19 / $1,023.99
| Professional | | $634.75 | $909.19 | $1,023.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $514.16 / $845.71 / $1,105.47
| Facility | | $514.16 | $845.71 | $1,105.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $580.89 / $701.84 / $1,261.49
| Professional | | $580.89 | $701.84 | $1,261.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $548.94 / $745.04 / $789.93
| Facility | | $548.94 | $745.04 | $789.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $514.16 / $947.03 / $3,274.00
| Facility | | $514.16 | $947.03 | $3,274.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $693.77 / $900.05 / $1,156.83
| Professional | | $693.77 | $900.05 | $1,156.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,909.34 / $10,952.22 / $13,050.49
| Facility | | $6,909.34 | $10,952.22 | $13,050.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $715.28 / $967.37 / $1,236.77
| Professional | | $715.28 | $967.37 | $1,236.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,981.00 / $9,074.00 / $12,786.00
| Facility | | $1,981.00 | $9,074.00 | $12,786.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $591.97 / $835.97 / $1,237.32
| Professional | | $591.97 | $835.97 | $1,237.32 |