- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $607.24 / $4,886.00 / $11,581.00
| Facility | | $607.24 | $4,886.00 | $11,581.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $515.96 / $607.24 / $1,260.45
| Professional | | $515.96 | $607.24 | $1,260.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,152.00 / $3,025.00 / $8,800.00
| Facility | | $1,152.00 | $3,025.00 | $8,800.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $452.41 / $709.72 / $1,217.84
| Professional | | $452.41 | $709.72 | $1,217.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $474.93 / $518.10 / $754.42
| Facility | | $474.93 | $518.10 | $754.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $472.16 / $655.66 / $834.47
| Professional | | $472.16 | $655.66 | $834.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21,571.00 / $21,571.00 / $21,571.00
| Facility | | $21,571.00 | $21,571.00 | $21,571.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $555.87 / $805.31 / $1,197.22
| Professional | | $555.87 | $805.31 | $1,197.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $910.23 / $910.23 / $910.23
| Facility | | $910.23 | $910.23 | $910.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $558.73 / $819.27 / $1,192.22
| Professional | | $558.73 | $819.27 | $1,192.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $72.32 / $420.26 / $760.22
| Professional | | $72.32 | $420.26 | $760.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,233.00 / $4,321.00 / $6,522.00
| Facility | | $2,233.00 | $4,321.00 | $6,522.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $553.47 / $830.21 / $1,407.58
| Professional | | $553.47 | $830.21 | $1,407.58 |