- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $882.00 / $3,142.00 / $8,017.00
| Facility | | $882.00 | $3,142.00 | $8,017.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $555.16 / $618.40 / $926.09
| Professional | | $555.16 | $618.40 | $926.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,292.00 / $5,951.00 / $9,100.00
| Facility | | $3,292.00 | $5,951.00 | $9,100.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $621.10 / $662.01 / $1,118.08
| Professional | | $621.10 | $662.01 | $1,118.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $701.19 / $701.19 / $701.19
| Facility | | $701.19 | $701.19 | $701.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $589.60 / $761.72 / $1,247.27
| Professional | | $589.60 | $761.72 | $1,247.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $734.67 / $1,001.39 / $1,268.97
| Professional | | $734.67 | $1,001.39 | $1,268.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,026.76 / $6,026.76 / $6,026.76
| Facility | | $6,026.76 | $6,026.76 | $6,026.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,013.00 / $3,839.00 / $8,017.00
| Facility | | $1,013.00 | $3,839.00 | $8,017.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $550.87 / $644.95 / $2,843.00
| Professional | | $550.87 | $644.95 | $2,843.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $745.00 / $745.00 / $1,294.20
| Professional | | $745.00 | $745.00 | $1,294.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $701.19 / $701.19 / $701.19
| Facility | | $701.19 | $701.19 | $701.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $589.60 / $776.63 / $1,303.58
| Professional | | $589.60 | $776.63 | $1,303.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $604.36 / $604.36 / $682.09
| Facility | | $604.36 | $604.36 | $682.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $583.37 / $609.75 / $682.09
| Professional | | $583.37 | $609.75 | $682.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,334.00 / $2,824.00 / $5,678.00
| Facility | | $1,334.00 | $2,824.00 | $5,678.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $586.22 / $757.14 / $1,166.99
| Professional | | $586.22 | $757.14 | $1,166.99 |