- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,266.51 / $5,412.00 / $11,024.00
| Facility | | $1,266.51 | $5,412.00 | $11,024.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $547.94 / $658.20 / $960.14
| Professional | | $547.94 | $658.20 | $960.14 |
- 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
- $578.01 / $747.88 / $1,236.47
| Professional | | $578.01 | $747.88 | $1,236.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $603.26 / $704.39 / $2,012.00
| Professional | | $603.26 | $704.39 | $2,012.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $714.96 / $714.96 / $776.00
| Facility | | $714.96 | $714.96 | $776.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $594.92 / $755.35 / $1,365.61
| Professional | | $594.92 | $755.35 | $1,365.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $603.98 / $773.99 / $914.72
| Professional | | $603.98 | $773.99 | $914.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $635.59 / $804.02 / $1,232.22
| Facility | | $635.59 | $804.02 | $1,232.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $747.00 / $854.00 / $1,217.00
| Professional | | $747.00 | $854.00 | $1,217.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $590.29 / $754.98 / $2,713.68
| Facility | | $590.29 | $754.98 | $2,713.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $590.29 / $759.97 / $2,713.68
| Professional | | $590.29 | $759.97 | $2,713.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,121.00 / $9,270.00 / $17,192.00
| Facility | | $5,121.00 | $9,270.00 | $17,192.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $461.45 / $729.58 / $1,163.03
| Professional | | $461.45 | $729.58 | $1,163.03 |