- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $543.63 / $4,771.00 / $9,539.00
| Facility | | $543.63 | $4,771.00 | $9,539.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $438.84 / $543.62 / $813.26
| Professional | | $438.84 | $543.62 | $813.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,104.00 / $9,336.50 / $13,003.86
| Facility | | $4,104.00 | $9,336.50 | $13,003.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $443.77 / $567.49 / $778.31
| Professional | | $443.77 | $567.49 | $778.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $559.16 / $668.00 / $1,163.04
| Professional | | $559.16 | $668.00 | $1,163.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $464.71 / $642.47 / $1,204.06
| Professional | | $464.71 | $642.47 | $1,204.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $444.44 / $533.33 / $657.77
| Professional | | $444.44 | $533.33 | $657.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $470.39 / $663.51 / $952.00
| Facility | | $470.39 | $663.51 | $952.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $607.00 / $700.00 / $1,099.49
| Professional | | $607.00 | $700.00 | $1,099.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $473.10 / $637.63 / $1,160.04
| Facility | | $473.10 | $637.63 | $1,160.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $473.10 / $637.63 / $1,160.04
| Professional | | $473.10 | $637.63 | $1,160.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,547.00 / $3,130.00 / $5,226.00
| Facility | | $1,547.00 | $3,130.00 | $5,226.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $399.67 / $676.39 / $1,032.75
| Professional | | $399.67 | $676.39 | $1,032.75 |