- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $776.81 / $5,087.00 / $8,920.00
| Facility | | $776.81 | $5,087.00 | $8,920.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $600.03 / $776.81 / $887.36
| Professional | | $600.03 | $776.81 | $887.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,671.00 / $14,495.61 / $20,189.45
| Facility | | $8,671.00 | $14,495.61 | $20,189.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $663.20 / $848.09 / $1,163.15
| Professional | | $663.20 | $848.09 | $1,163.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $841.68 / $1,015.91 / $1,768.77
| Professional | | $841.68 | $1,015.91 | $1,768.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $660.14 / $930.09 / $1,768.94
| Professional | | $660.14 | $930.09 | $1,768.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $677.17 / $812.60 / $1,002.21
| Professional | | $677.17 | $812.60 | $1,002.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $671.62 / $949.35 / $1,279.79
| Facility | | $671.62 | $949.35 | $1,279.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $861.00 / $985.00 / $1,676.83
| Professional | | $861.00 | $985.00 | $1,676.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $678.45 / $932.94 / $5,122.00
| Facility | | $678.45 | $932.94 | $5,122.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $678.45 / $932.94 / $5,122.00
| Professional | | $678.45 | $932.94 | $5,122.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,303.00 / $9,373.00 / $17,192.00
| Facility | | $6,303.00 | $9,373.00 | $17,192.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $587.17 / $897.00 / $1,557.59
| Professional | | $587.17 | $897.00 | $1,557.59 |