- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,088.00 / $3,645.00 / $8,294.00
| Facility | | $1,088.00 | $3,645.00 | $8,294.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $604.87 / $830.87 / $1,214.76
| Professional | | $604.87 | $830.87 | $1,214.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,823.00 / $12,004.00 / $15,528.00
| Facility | | $9,823.00 | $12,004.00 | $15,528.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $838.50 / $1,096.08 / $1,812.14
| Professional | | $838.50 | $1,096.08 | $1,812.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $697.09 / $829.54 / $9,951.00
| Professional | | $697.09 | $829.54 | $9,951.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $572.00 / $572.00 / $1,039.80
| Facility | | $572.00 | $572.00 | $1,039.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $731.93 / $942.35 / $1,846.36
| Professional | | $731.93 | $942.35 | $1,846.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $875.47 / $1,132.97 / $1,338.96
| Professional | | $875.47 | $1,132.97 | $1,338.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $759.57 / $983.65 / $1,520.49
| Facility | | $759.57 | $983.65 | $1,520.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $671.00 / $948.00 / $1,633.59
| Professional | | $671.00 | $948.00 | $1,633.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $665.55 / $959.72 / $3,465.18
| Facility | | $665.55 | $959.72 | $3,465.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $665.55 / $959.72 / $3,465.18
| Professional | | $665.55 | $959.72 | $3,465.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,121.00 / $9,270.00 / $17,192.00
| Facility | | $5,121.00 | $9,270.00 | $17,192.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $584.53 / $918.54 / $1,536.35
| Professional | | $584.53 | $918.54 | $1,536.35 |