- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $652.00 / $2,514.00 / $7,495.00
| Facility | | $652.00 | $2,514.00 | $7,495.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $549.09 / $709.46 / $1,043.31
| Professional | | $549.09 | $709.46 | $1,043.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,232.96 / $4,495.71 / $8,663.91
| Facility | | $2,232.96 | $4,495.71 | $8,663.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $678.20 / $860.88 / $1,267.26
| Professional | | $678.20 | $860.88 | $1,267.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $640.70 / $640.70 / $826.85
| Facility | | $640.70 | $640.70 | $826.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $679.78 / $872.78 / $1,330.32
| Professional | | $679.78 | $872.78 | $1,330.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,006.88 / $16,394.00 / $16,394.00
| Facility | | $5,006.88 | $16,394.00 | $16,394.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,264.88 / $5,725.36 / $6,772.43
| Professional | | $5,264.88 | $5,725.36 | $6,772.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $660.87 / $814.34 / $1,088.16
| Facility | | $660.87 | $814.34 | $1,088.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $838.53 / $1,165.94 / $1,445.76
| Professional | | $838.53 | $1,165.94 | $1,445.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $691.64 / $827.10 / $1,086.58
| Professional | | $691.64 | $827.10 | $1,086.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $647.87 / $814.94 / $1,161.24
| Facility | | $647.87 | $814.94 | $1,161.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $693.11 / $929.10 / $1,484.74
| Professional | | $693.11 | $929.10 | $1,484.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,634.00 / $4,345.00 / $10,600.00
| Facility | | $1,634.00 | $4,345.00 | $10,600.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $617.21 / $826.87 / $1,171.16
| Professional | | $617.21 | $826.87 | $1,171.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $663.39 / $751.91 / $1,047.78
| Professional | | $663.39 | $751.91 | $1,047.78 |