- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $938.50 / $4,882.63 / $9,347.59
| Facility | | $938.50 | $4,882.63 | $9,347.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $574.99 / $827.18 / $1,423.27
| Professional | | $574.99 | $827.18 | $1,423.27 |
- 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
- $627.86 / $802.90 / $1,101.17
| Professional | | $627.86 | $802.90 | $1,101.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $739.39 / $1,095.05 / $5,036.00
| Professional | | $739.39 | $1,095.05 | $5,036.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $552.60 / $832.39 / $1,587.61
| Professional | | $552.60 | $832.39 | $1,587.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $639.79 / $767.75 / $946.89
| Professional | | $639.79 | $767.75 | $946.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $705.92 / $840.09 / $1,280.36
| Facility | | $705.92 | $840.09 | $1,280.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $726.56 / $871.00 / $1,520.00
| Professional | | $726.56 | $871.00 | $1,520.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $578.69 / $826.13 / $3,512.00
| Facility | | $578.69 | $826.13 | $3,512.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $578.69 / $826.13 / $3,512.00
| Professional | | $578.69 | $826.13 | $3,512.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,524.00 / $5,979.00 / $13,217.00
| Facility | | $3,524.00 | $5,979.00 | $13,217.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $494.23 / $737.90 / $1,389.92
| Professional | | $494.23 | $737.90 | $1,389.92 |