- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $811.71 / $4,771.00 / $9,539.00
| Facility | | $811.71 | $4,771.00 | $9,539.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $715.55 / $811.71 / $907.63
| Professional | | $715.55 | $811.71 | $907.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,162.00 / $17,132.29 / $23,861.81
| Facility | | $11,162.00 | $17,132.29 | $23,861.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $673.66 / $861.46 / $1,181.49
| Professional | | $673.66 | $861.46 | $1,181.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $898.48 / $1,063.59 / $1,851.80
| Professional | | $898.48 | $1,063.59 | $1,851.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $701.87 / $959.29 / $1,834.08
| Professional | | $701.87 | $959.29 | $1,834.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $686.93 / $824.32 / $1,016.66
| Professional | | $686.93 | $824.32 | $1,016.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $798.01 / $963.98 / $1,427.71
| Facility | | $798.01 | $963.98 | $1,427.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $869.00 / $1,023.00 / $1,688.54
| Professional | | $869.00 | $1,023.00 | $1,688.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $703.93 / $936.05 / $2,070.00
| Facility | | $703.93 | $936.05 | $2,070.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $703.93 / $936.05 / $2,070.00
| Professional | | $703.93 | $936.05 | $2,070.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,547.00 / $3,130.00 / $5,226.00
| Facility | | $1,547.00 | $3,130.00 | $5,226.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $597.22 / $858.51 / $1,590.58
| Professional | | $597.22 | $858.51 | $1,590.58 |