- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $549.54 / $4,897.79 / $8,912.51
| Facility | | $549.54 | $4,897.79 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $436.52 / $549.54 / $870.96
| Professional | | $436.52 | $549.54 | $870.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,772.37 / $11,220.18 / $12,302.69
| Facility | | $9,772.37 | $11,220.18 | $12,302.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $446.68 / $602.56 / $851.14
| Professional | | $446.68 | $602.56 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $501.19 / $776.25 / $8,317.64
| Professional | | $501.19 | $776.25 | $8,317.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $467.74 / $630.96 / $1,096.48
| Professional | | $467.74 | $630.96 | $1,096.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $426.58 / $524.81 / $1,348.96
| Professional | | $426.58 | $524.81 | $1,348.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $707.95 / $891.25 / $1,096.48
| Professional | | $707.95 | $891.25 | $1,096.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $489.78 / $691.83 / $1,047.13
| Facility | | $489.78 | $691.83 | $1,047.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $446.68 / $645.65 / $10,000.00
| Facility | | $446.68 | $645.65 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $446.68 / $645.65 / $10,000.00
| Professional | | $446.68 | $645.65 | $10,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,760.83 / $11,748.98 / $23,988.33
| Facility | | $6,760.83 | $11,748.98 | $23,988.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $398.11 / $630.96 / $1,000.00
| Professional | | $398.11 | $630.96 | $1,000.00 |