- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $715.97 / $2,747.00 / $7,920.26
| Facility | | $715.97 | $2,747.00 | $7,920.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $312.19 / $474.34 / $1,717.87
| Professional | | $312.19 | $474.34 | $1,717.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $736.00 / $736.00 / $736.00
| Facility | | $736.00 | $736.00 | $736.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $488.61 / $804.30 / $1,231.51
| Professional | | $488.61 | $804.30 | $1,231.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $696.09 / $877.61 / $1,126.04
| Professional | | $696.09 | $877.61 | $1,126.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $466.24 / $709.52 / $1,087.76
| Facility | | $466.24 | $709.52 | $1,087.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $557.38 / $758.82 / $1,077.94
| Professional | | $557.38 | $758.82 | $1,077.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $549.13 / $850.26 / $938.67
| Facility | | $549.13 | $850.26 | $938.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $466.24 / $734.97 / $1,316.20
| Facility | | $466.24 | $734.97 | $1,316.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $606.57 / $852.39 / $1,183.88
| Professional | | $606.57 | $852.39 | $1,183.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,364.17 / $10,171.54 / $12,117.15
| Facility | | $6,364.17 | $10,171.54 | $12,117.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $611.63 / $875.93 / $1,281.97
| Professional | | $611.63 | $875.93 | $1,281.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,981.00 / $9,074.00 / $12,786.00
| Facility | | $1,981.00 | $9,074.00 | $12,786.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $655.67 / $956.19 / $1,426.05
| Professional | | $655.67 | $956.19 | $1,426.05 |