- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $553.08 / $3,633.00 / $8,294.00
| Facility | | $553.08 | $3,633.00 | $8,294.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $411.42 / $563.29 / $835.90
| Professional | | $411.42 | $563.29 | $835.90 |
- 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
- $435.78 / $557.27 / $773.82
| Professional | | $435.78 | $557.27 | $773.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $508.54 / $991.69 / $4,284.00
| Professional | | $508.54 | $991.69 | $4,284.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $786.18 / $786.18 / $786.18
| Facility | | $786.18 | $786.18 | $786.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $452.11 / $669.14 / $1,171.91
| Professional | | $452.11 | $669.14 | $1,171.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $598.14 / $703.69 / $892.00
| Professional | | $598.14 | $703.69 | $892.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $450.77 / $655.91 / $1,059.08
| Facility | | $450.77 | $655.91 | $1,059.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $785.00 / $878.00 / $1,180.00
| Professional | | $785.00 | $878.00 | $1,180.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $449.20 / $587.99 / $7,420.00
| Facility | | $449.20 | $587.99 | $7,420.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $559.08 / $785.55 / $7,420.00
| Professional | | $559.08 | $785.55 | $7,420.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,349.00 / $6,870.00 / $12,739.00
| Facility | | $4,349.00 | $6,870.00 | $12,739.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $454.03 / $649.88 / $1,177.20
| Professional | | $454.03 | $649.88 | $1,177.20 |