- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $554.53 / $2,172.00 / $7,513.00
| Facility | | $554.53 | $2,172.00 | $7,513.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $506.87 / $554.53 / $773.54
| Professional | | $506.87 | $554.53 | $773.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $523.14 / $896.01 / $1,951.32
| Facility | | $523.14 | $896.01 | $1,951.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $478.64 / $605.03 / $659.02
| Professional | | $478.64 | $605.03 | $659.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $458.02 / $458.02 / $458.02
| Facility | | $458.02 | $458.02 | $458.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $453.50 / $453.50 / $453.50
| Facility | | $453.50 | $453.50 | $453.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $545.84 / $713.03 / $1,095.98
| Professional | | $545.84 | $713.03 | $1,095.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $55.00 / $4,777.60
| Facility | | $55.00 | $55.00 | $4,777.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,821.36 / $3,905.52 / $4,349.03
| Professional | | $3,821.36 | $3,905.52 | $4,349.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $508.55 / $690.14 / $1,176.59
| Facility | | $508.55 | $690.14 | $1,176.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $661.87 / $778.97 / $916.43
| Professional | | $661.87 | $778.97 | $916.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $809.70 / $809.70 / $809.70
| Professional | | $809.70 | $809.70 | $809.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $508.55 / $702.48 / $1,247.69
| Facility | | $508.55 | $702.48 | $1,247.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $548.48 / $731.35 / $1,115.08
| Professional | | $548.48 | $731.35 | $1,115.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $369.00 / $1,529.00 / $3,287.00
| Facility | | $369.00 | $1,529.00 | $3,287.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $442.89 / $608.97 / $941.14
| Professional | | $442.89 | $608.97 | $941.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $434.53 / $499.06 / $686.80
| Professional | | $434.53 | $499.06 | $686.80 |