- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $658.01 / $2,808.30 / $7,542.00
| Facility | | $658.01 | $2,808.30 | $7,542.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $444.56 / $538.71 / $906.03
| Professional | | $444.56 | $538.71 | $906.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,971.06 / $3,640.66 / $7,206.00
| Facility | | $1,971.06 | $3,640.66 | $7,206.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $488.20 / $620.27 / $847.85
| Professional | | $488.20 | $620.27 | $847.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $597.26 / $632.70 / $879.45
| Professional | | $597.26 | $632.70 | $879.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $479.10 / $3,507.84 / $3,507.84
| Facility | | $479.10 | $3,507.84 | $3,507.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $601.70 / $601.70 / $601.70
| Facility | | $601.70 | $601.70 | $601.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $493.80 / $681.00 / $1,041.47
| Professional | | $493.80 | $681.00 | $1,041.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,973.18 / $11,500.00 / $16,394.00
| Facility | | $2,973.18 | $11,500.00 | $16,394.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,836.80 / $3,922.80 / $4,549.72
| Professional | | $3,836.80 | $3,922.80 | $4,549.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $444.56 / $572.61 / $924.14
| Facility | | $444.56 | $572.61 | $924.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $652.19 / $798.28 / $970.46
| Professional | | $652.19 | $798.28 | $970.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $441.60 / $667.41 / $871.33
| Professional | | $441.60 | $667.41 | $871.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $444.57 / $573.77 / $984.72
| Facility | | $444.57 | $573.77 | $984.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $510.91 / $703.45 / $1,097.94
| Professional | | $510.91 | $703.45 | $1,097.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,154.00 / $3,326.00 / $7,600.00
| Facility | | $1,154.00 | $3,326.00 | $7,600.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $410.59 / $549.28 / $859.47
| Professional | | $410.59 | $549.28 | $859.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $445.30 / $506.16 / $702.28
| Professional | | $445.30 | $506.16 | $702.28 |