- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $779.33 / $5,048.00 / $14,650.53
| Facility | | $779.33 | $5,048.00 | $14,650.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $681.88 / $779.33 / $1,538.85
| Professional | | $681.88 | $779.33 | $1,538.85 |
- 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
- $625.71 / $800.15 / $1,097.40
| Professional | | $625.71 | $800.15 | $1,097.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $752.87 / $880.86 / $1,468.10
| Professional | | $752.87 | $880.86 | $1,468.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $689.66 / $928.79 / $1,677.23
| Professional | | $689.66 | $928.79 | $1,677.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $649.21 / $779.05 / $924.39
| Professional | | $649.21 | $779.05 | $924.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $739.51 / $921.91 / $1,317.07
| Facility | | $739.51 | $921.91 | $1,317.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $852.00 / $942.00 / $1,669.00
| Professional | | $852.00 | $942.00 | $1,669.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $695.48 / $917.38 / $3,512.00
| Facility | | $695.48 | $917.38 | $3,512.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $695.48 / $917.38 / $3,512.00
| Professional | | $695.48 | $917.38 | $3,512.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,349.00 / $7,061.00 / $12,739.00
| Facility | | $4,349.00 | $7,061.00 | $12,739.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $556.74 / $897.74 / $1,468.11
| Professional | | $556.74 | $897.74 | $1,468.11 |