- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $776.90 / $4,962.67 / $15,341.00
| Facility | | $776.90 | $4,962.67 | $15,341.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $308.91 / $497.46 / $1,223.77
| Professional | | $308.91 | $497.46 | $1,223.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $529.41 / $835.08 / $1,326.11
| Professional | | $529.41 | $835.08 | $1,326.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $567.73 / $825.78 / $1,147.61
| Professional | | $567.73 | $825.78 | $1,147.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $475.36 / $761.16 / $1,171.26
| Facility | | $475.36 | $761.16 | $1,171.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $567.34 / $786.06 / $1,127.80
| Professional | | $567.34 | $786.06 | $1,127.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $627.12 / $915.04 / $990.93
| Facility | | $627.12 | $915.04 | $990.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $486.31 / $807.31 / $3,005.10
| Facility | | $486.31 | $807.31 | $3,005.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $641.35 / $901.07 / $1,238.66
| Professional | | $641.35 | $901.07 | $1,238.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,382.73 / $9,212.20 / $12,052.68
| Facility | | $7,382.73 | $9,212.20 | $12,052.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $660.48 / $951.65 / $1,395.67
| Professional | | $660.48 | $951.65 | $1,395.67 |
- 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
- $630.21 / $948.06 / $1,443.93
| Professional | | $630.21 | $948.06 | $1,443.93 |