- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $657.00 / $2,124.00 / $7,316.00
| Facility | | $657.00 | $2,124.00 | $7,316.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $655.45 / $816.86 / $1,203.74
| Professional | | $655.45 | $816.86 | $1,203.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $458.81 / $821.65 / $3,132.54
| Facility | | $458.81 | $821.65 | $3,132.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $660.21 / $847.52 / $1,329.47
| Professional | | $660.21 | $847.52 | $1,329.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $80.00 / $652.70 / $652.70
| Facility | | $80.00 | $652.70 | $652.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,151.71 / $1,151.71 / $1,151.71
| Facility | | $1,151.71 | $1,151.71 | $1,151.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $697.81 / $971.86 / $1,508.93
| Professional | | $697.81 | $971.86 | $1,508.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $55.00 / $5,021.52
| Facility | | $55.00 | $55.00 | $5,021.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,111.12 / $6,144.16 / $7,146.23
| Professional | | $5,111.12 | $6,144.16 | $7,146.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $559.70 / $838.29 / $1,384.05
| Facility | | $559.70 | $838.29 | $1,384.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $891.48 / $1,131.49 / $1,486.46
| Professional | | $891.48 | $1,131.49 | $1,486.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $512.90 / $512.90 / $512.90
| Professional | | $512.90 | $512.90 | $512.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $560.66 / $840.52 / $1,447.79
| Facility | | $560.66 | $840.52 | $1,447.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $713.15 / $1,032.07 / $1,645.56
| Professional | | $713.15 | $1,032.07 | $1,645.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $774.00 / $2,494.00 / $4,739.00
| Facility | | $774.00 | $2,494.00 | $4,739.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $631.94 / $851.35 / $1,322.87
| Professional | | $631.94 | $851.35 | $1,322.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $704.80 / $790.83 / $1,120.28
| Professional | | $704.80 | $790.83 | $1,120.28 |