- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $673.61 / $5,048.00 / $8,294.00
| Facility | | $673.61 | $5,048.00 | $8,294.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $554.35 / $668.68 / $1,360.77
| Professional | | $554.35 | $668.68 | $1,360.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,060.00 / $3,693.00 / $4,290.00
| Facility | | $3,060.00 | $3,693.00 | $4,290.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $540.89 / $691.68 / $948.63
| Professional | | $540.89 | $691.68 | $948.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $649.65 / $938.16 / $4,284.00
| Professional | | $649.65 | $938.16 | $4,284.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $595.65 / $790.25 / $1,465.27
| Professional | | $595.65 | $790.25 | $1,465.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $560.72 / $672.86 / $829.87
| Professional | | $560.72 | $672.86 | $829.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $658.11 / $820.85 / $1,203.08
| Facility | | $658.11 | $820.85 | $1,203.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $744.00 / $840.00 / $1,375.44
| Professional | | $744.00 | $840.00 | $1,375.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $579.49 / $795.12 / $4,071.00
| Facility | | $579.49 | $795.12 | $4,071.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $579.49 / $795.12 / $4,071.00
| Professional | | $579.49 | $795.12 | $4,071.00 |
- 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
- $499.12 / $771.24 / $1,280.35
| Professional | | $499.12 | $771.24 | $1,280.35 |