- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $976.54 / $4,011.00 / $18,711.00
| Facility | | $976.54 | $4,011.00 | $18,711.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $504.80 / $676.32 / $1,465.26
| Professional | | $504.80 | $676.32 | $1,465.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,478.12 / $9,172.83 / $17,546.59
| Facility | | $3,478.12 | $9,172.83 | $17,546.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $752.17 / $1,235.51 / $4,922.89
| Professional | | $752.17 | $1,235.51 | $4,922.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $625.25 / $761.81 / $3,740.43
| Facility | | $625.25 | $761.81 | $3,740.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $562.96 / $952.15 / $1,619.49
| Professional | | $562.96 | $952.15 | $1,619.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $569.83 / $1,134.17 / $3,280.24
| Facility | | $569.83 | $1,134.17 | $3,280.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $544.83 / $1,105.11 / $2,824.57
| Professional | | $544.83 | $1,105.11 | $2,824.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $77.42 / $317.80 / $1,082.01
| Professional | | $77.42 | $317.80 | $1,082.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $745.21 / $993.61 / $1,071.33
| Facility | | $745.21 | $993.61 | $1,071.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $705.77 / $730.74 / $2,961.46
| Facility | | $705.77 | $730.74 | $2,961.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $812.32 / $1,162.47 / $1,450.45
| Professional | | $812.32 | $1,162.47 | $1,450.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,693.27 / $9,167.59 / $17,546.59
| Facility | | $6,693.27 | $9,167.59 | $17,546.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $719.80 / $1,040.11 / $1,391.28
| Professional | | $719.80 | $1,040.11 | $1,391.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,129.00 / $11,604.61 / $18,561.84
| Facility | | $3,129.00 | $11,604.61 | $18,561.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $628.32 / $852.72 / $1,501.96
| Professional | | $628.32 | $852.72 | $1,501.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $445.57 / $445.57 / $583.46
| Professional | | $445.57 | $445.57 | $583.46 |