- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $874.06 / $2,747.00 / $7,920.26
| Facility | | $874.06 | $2,747.00 | $7,920.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $359.51 / $460.76 / $1,091.19
| Professional | | $359.51 | $460.76 | $1,091.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $550.00 / $550.00 / $550.00
| Facility | | $550.00 | $550.00 | $550.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $470.05 / $824.52 / $1,227.34
| Professional | | $470.05 | $824.52 | $1,227.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $815.88 / $977.76 / $1,117.35
| Professional | | $815.88 | $977.76 | $1,117.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $464.55 / $742.32 / $1,032.75
| Facility | | $464.55 | $742.32 | $1,032.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $648.44 / $735.95 / $1,177.52
| Professional | | $648.44 | $735.95 | $1,177.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $567.32 / $793.21 / $913.88
| Facility | | $567.32 | $793.21 | $913.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $523.79 / $749.47 / $1,169.96
| Facility | | $523.79 | $749.47 | $1,169.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $717.03 / $870.24 / $1,195.38
| Professional | | $717.03 | $870.24 | $1,195.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,820.30 / $4,901.89 / $6,016.60
| Facility | | $3,820.30 | $4,901.89 | $6,016.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $759.04 / $999.24 / $1,315.45
| Professional | | $759.04 | $999.24 | $1,315.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,106.00 / $2,385.00 / $7,480.00
| Facility | | $1,106.00 | $2,385.00 | $7,480.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $594.79 / $845.23 / $1,340.44
| Professional | | $594.79 | $845.23 | $1,340.44 |