- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $898.09 / $3,066.00 / $7,799.00
| Facility | | $898.09 | $3,066.00 | $7,799.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $765.47 / $856.91 / $1,412.91
| Professional | | $765.47 | $856.91 | $1,412.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,393.00 / $11,479.00 / $18,724.00
| Facility | | $6,393.00 | $11,479.00 | $18,724.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $896.46 / $930.29 / $1,662.37
| Professional | | $896.46 | $930.29 | $1,662.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,017.00 / $1,017.00 / $1,017.00
| Facility | | $1,017.00 | $1,017.00 | $1,017.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $763.76 / $1,044.49 / $1,745.13
| Professional | | $763.76 | $1,044.49 | $1,745.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,073.42 / $1,485.04 / $1,854.10
| Professional | | $1,073.42 | $1,485.04 | $1,854.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $954.00 / $3,839.00 / $8,017.00
| Facility | | $954.00 | $3,839.00 | $8,017.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $771.45 / $965.80 / $4,253.72
| Professional | | $771.45 | $965.80 | $4,253.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $872.50 / $872.50 / $1,806.50
| Professional | | $872.50 | $872.50 | $1,806.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,017.00 / $1,017.00 / $1,017.00
| Facility | | $1,017.00 | $1,017.00 | $1,017.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $767.21 / $1,063.16 / $1,753.34
| Professional | | $767.21 | $1,063.16 | $1,753.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $734.96 / $849.97 / $849.97
| Facility | | $734.96 | $849.97 | $849.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $734.96 / $849.97 / $904.57
| Professional | | $734.96 | $849.97 | $904.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,468.00 / $4,563.00 / $9,631.00
| Facility | | $2,468.00 | $4,563.00 | $9,631.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $762.04 / $1,033.36 / $1,784.93
| Professional | | $762.04 | $1,033.36 | $1,784.93 |