- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $859.12 / $5,087.00 / $8,294.00
| Facility | | $859.12 | $5,087.00 | $8,294.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $531.14 / $675.28 / $959.85
| Professional | | $531.14 | $675.28 | $959.85 |
- 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
- $607.00 / $779.66 / $1,101.81
| Professional | | $607.00 | $779.66 | $1,101.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $720.55 / $1,415.21 / $3,472.00
| Professional | | $720.55 | $1,415.21 | $3,472.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $754.36 / $754.36 / $754.36
| Facility | | $754.36 | $754.36 | $754.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $609.39 / $805.88 / $1,284.76
| Professional | | $609.39 | $805.88 | $1,284.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $628.11 / $738.95 / $952.84
| Professional | | $628.11 | $738.95 | $952.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $590.34 / $828.95 / $1,242.40
| Facility | | $590.34 | $828.95 | $1,242.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $847.00 / $946.00 / $1,274.01
| Professional | | $847.00 | $946.00 | $1,274.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $604.89 / $850.36 / $7,420.00
| Facility | | $604.89 | $850.36 | $7,420.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $604.89 / $850.36 / $7,420.00
| Professional | | $604.89 | $850.36 | $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
- $496.96 / $638.00 / $1,084.92
| Professional | | $496.96 | $638.00 | $1,084.92 |