- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $947.29 / $14,614.14 / $23,856.49
| Facility | | $947.29 | $14,614.14 | $23,856.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $413.01 / $610.69 / $2,221.84
| Professional | | $413.01 | $610.69 | $2,221.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $595.53 / $931.42 / $1,271.51
| Professional | | $595.53 | $931.42 | $1,271.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $694.86 / $995.02 / $1,120.73
| Professional | | $694.86 | $995.02 | $1,120.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $610.69 / $914.23 / $1,312.98
| Facility | | $610.69 | $914.23 | $1,312.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $633.41 / $764.94 / $1,380.32
| Professional | | $633.41 | $764.94 | $1,380.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $599.33 / $810.10 / $866.31
| Facility | | $599.33 | $810.10 | $866.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $610.69 / $1,033.34 / $9,999.15
| Facility | | $610.69 | $1,033.34 | $9,999.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $758.89 / $986.72 / $1,266.25
| Professional | | $758.89 | $986.72 | $1,266.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,624.30 / $17,810.43 / $21,600.03
| Facility | | $13,624.30 | $17,810.43 | $21,600.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $782.93 / $1,060.91 / $1,356.36
| Professional | | $782.93 | $1,060.91 | $1,356.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,028.00 / $18,628.00 / $26,255.00
| Facility | | $3,028.00 | $18,628.00 | $26,255.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $655.61 / $911.57 / $1,354.33
| Professional | | $655.61 | $911.57 | $1,354.33 |