- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $743.35 / $1,187.32 / $11,348.00
| Facility | | $743.35 | $1,187.32 | $11,348.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $308.30 / $473.67 / $1,246.84
| Professional | | $308.30 | $473.67 | $1,246.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $842.00 / $842.00 / $842.00
| Facility | | $842.00 | $842.00 | $842.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $474.46 / $829.25 / $1,318.69
| Professional | | $474.46 | $829.25 | $1,318.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $709.59 / $893.84 / $1,190.60
| Professional | | $709.59 | $893.84 | $1,190.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $471.80 / $717.07 / $1,115.24
| Facility | | $471.80 | $717.07 | $1,115.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $556.79 / $778.39 / $1,108.28
| Professional | | $556.79 | $778.39 | $1,108.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $571.24 / $902.40 / $978.87
| Facility | | $571.24 | $902.40 | $978.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $473.67 / $737.53 / $1,357.86
| Facility | | $473.67 | $737.53 | $1,357.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $619.85 / $896.49 / $1,264.64
| Professional | | $619.85 | $896.49 | $1,264.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,715.78 / $9,638.43 / $12,117.15
| Facility | | $7,715.78 | $9,638.43 | $12,117.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $624.00 / $924.48 / $1,362.74
| Professional | | $624.00 | $924.48 | $1,362.74 |
- 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
- $696.28 / $994.70 / $1,600.00
| Professional | | $696.28 | $994.70 | $1,600.00 |