- 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
- $585.44 / $694.06 / $924.96
| Professional | | $585.44 | $694.06 | $924.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,032.00 / $6,548.00 / $7,221.00
| Facility | | $5,032.00 | $6,548.00 | $7,221.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $609.29 / $788.36 / $1,303.39
| Professional | | $609.29 | $788.36 | $1,303.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $675.38 / $749.67 / $1,276.47
| Professional | | $675.38 | $749.67 | $1,276.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $572.00 / $572.00 / $752.89
| Facility | | $572.00 | $572.00 | $752.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $631.91 / $815.46 / $1,439.28
| Professional | | $631.91 | $815.46 | $1,439.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $636.03 / $814.48 / $962.57
| Professional | | $636.03 | $814.48 | $962.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $679.55 / $852.29 / $1,293.00
| Facility | | $679.55 | $852.29 | $1,293.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $816.00 / $889.00 / $1,232.00
| Professional | | $816.00 | $889.00 | $1,232.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $638.05 / $820.07 / $2,801.20
| Facility | | $638.05 | $820.07 | $2,801.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $638.05 / $820.07 / $2,801.20
| Professional | | $638.05 | $820.07 | $2,801.20 |
- 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
- $497.19 / $818.66 / $1,321.93
| Professional | | $497.19 | $818.66 | $1,321.93 |