- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $716.48 / $8,609.02 / $14,491.00
| Facility | | $716.48 | $8,609.02 | $14,491.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $356.60 / $449.48 / $1,731.00
| Professional | | $356.60 | $449.48 | $1,731.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $513.11 / $869.29 / $1,116.78
| Professional | | $513.11 | $869.29 | $1,116.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $671.82 / $852.53 / $1,001.02
| Professional | | $671.82 | $852.53 | $1,001.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $390.90 / $700.96 / $966.38
| Facility | | $390.90 | $700.96 | $966.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $592.20 / $695.40 / $1,198.91
| Professional | | $592.20 | $695.40 | $1,198.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $520.09 / $730.17 / $868.32
| Facility | | $520.09 | $730.17 | $868.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $390.90 / $843.05 / $3,743.00
| Facility | | $390.90 | $843.05 | $3,743.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $685.44 / $919.12 / $1,173.54
| Professional | | $685.44 | $919.12 | $1,173.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,041.14 / $9,224.37 / $11,703.59
| Facility | | $7,041.14 | $9,224.37 | $11,703.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $718.87 / $956.83 / $1,222.28
| Professional | | $718.87 | $956.83 | $1,222.28 |
- 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
- $623.79 / $981.61 / $1,431.88
| Professional | | $623.79 | $981.61 | $1,431.88 |