- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $766.30 / $3,053.00 / $7,343.00
| Facility | | $766.30 | $3,053.00 | $7,343.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $464.05 / $688.48 / $1,067.71
| Professional | | $464.05 | $688.48 | $1,067.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,393.00 / $4,120.00 / $8,836.00
| Facility | | $2,393.00 | $4,120.00 | $8,836.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $460.39 / $601.83 / $1,353.55
| Professional | | $460.39 | $601.83 | $1,353.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $793.07 / $793.07 / $4,050.00
| Facility | | $793.07 | $793.07 | $4,050.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $793.07 / $793.07 / $793.07
| Professional | | $793.07 | $793.07 | $793.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $637.85 / $637.85 / $3,479.91
| Facility | | $637.85 | $637.85 | $3,479.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $525.00 / $976.30 / $2,179.23
| Professional | | $525.00 | $976.30 | $2,179.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $319.00 / $939.58 / $1,531.20
| Facility | | $319.00 | $939.58 | $1,531.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $631.78 / $756.89 / $1,132.72
| Professional | | $631.78 | $756.89 | $1,132.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $447.54 / $678.59 / $1,008.70
| Professional | | $447.54 | $678.59 | $1,008.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $555.00 / $637.85 / $3,479.91
| Facility | | $555.00 | $637.85 | $3,479.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $569.65 / $966.32 / $2,032.21
| Professional | | $569.65 | $966.32 | $2,032.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,348.00 / $3,496.00 / $5,963.00
| Facility | | $1,348.00 | $3,496.00 | $5,963.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $455.17 / $701.73 / $1,759.01
| Professional | | $455.17 | $701.73 | $1,759.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $720.50 / $720.50 / $2,019.07
| Facility | | $720.50 | $720.50 | $2,019.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $447.54 / $720.50 / $1,176.83
| Professional | | $447.54 | $720.50 | $1,176.83 |