- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,114.35 / $5,087.00 / $8,294.00
| Facility | | $1,114.35 | $5,087.00 | $8,294.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $641.58 / $842.27 / $1,114.35
| Professional | | $641.58 | $842.27 | $1,114.35 |
- 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
- $747.67 / $986.25 / $1,393.76
| Professional | | $747.67 | $986.25 | $1,393.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $854.97 / $1,667.19 / $6,694.00
| Professional | | $854.97 | $1,667.19 | $6,694.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $952.18 / $952.18 / $952.18
| Facility | | $952.18 | $952.18 | $952.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $660.89 / $922.91 / $1,567.69
| Professional | | $660.89 | $922.91 | $1,567.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $793.88 / $933.98 / $1,186.75
| Professional | | $793.88 | $933.98 | $1,186.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $695.28 / $905.76 / $1,501.43
| Facility | | $695.28 | $905.76 | $1,501.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $885.00 / $1,019.00 / $1,623.34
| Professional | | $885.00 | $1,019.00 | $1,623.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $656.68 / $968.73 / $9,210.00
| Facility | | $656.68 | $968.73 | $9,210.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $656.68 / $968.73 / $9,210.00
| Professional | | $656.68 | $968.73 | $9,210.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,303.00 / $9,270.00 / $17,192.00
| Facility | | $6,303.00 | $9,270.00 | $17,192.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $520.53 / $734.21 / $1,330.72
| Professional | | $520.53 | $734.21 | $1,330.72 |