- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,136.59 / $5,388.00 / $9,347.59
| Facility | | $1,136.59 | $5,388.00 | $9,347.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $473.30 / $594.99 / $775.28
| Professional | | $473.30 | $594.99 | $775.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,060.00 / $3,693.00 / $4,290.00
| Facility | | $3,060.00 | $3,693.00 | $4,290.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $520.29 / $673.21 / $1,113.01
| Professional | | $520.29 | $673.21 | $1,113.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $600.15 / $647.71 / $3,019.00
| Professional | | $600.15 | $647.71 | $3,019.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $644.64 / $644.64 / $776.00
| Facility | | $644.64 | $644.64 | $776.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $516.99 / $676.54 / $1,206.71
| Professional | | $516.99 | $676.54 | $1,206.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $545.39 / $702.54 / $830.27
| Professional | | $545.39 | $702.54 | $830.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $525.27 / $698.31 / $1,045.46
| Facility | | $525.27 | $698.31 | $1,045.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $642.34 / $765.00 / $1,075.00
| Professional | | $642.34 | $765.00 | $1,075.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $490.86 / $687.59 / $1,683.00
| Facility | | $490.86 | $687.59 | $1,683.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $490.86 / $687.59 / $1,683.00
| Professional | | $490.86 | $687.59 | $1,683.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,713.00 / $2,863.00 / $5,340.00
| Facility | | $1,713.00 | $2,863.00 | $5,340.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $401.17 / $622.60 / $1,034.26
| Professional | | $401.17 | $622.60 | $1,034.26 |