- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $571.66 / $2,663.12 / $4,410.00
| Facility | | $571.66 | $2,663.12 | $4,410.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $474.11 / $596.97 / $904.29
| Professional | | $474.11 | $596.97 | $904.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,061.00 / $3,218.40 / $9,039.00
| Facility | | $1,061.00 | $3,218.40 | $9,039.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $437.49 / $820.02 / $3,417.12
| Professional | | $437.49 | $820.02 | $3,417.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $558.21 / $724.56 / $1,280.53
| Facility | | $558.21 | $724.56 | $1,280.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $705.02 / $1,001.93 / $1,418.53
| Professional | | $705.02 | $1,001.93 | $1,418.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,346.32 / $1,346.32 / $1,346.32
| Facility | | $1,346.32 | $1,346.32 | $1,346.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $479.70 / $936.34 / $1,744.82
| Professional | | $479.70 | $936.34 | $1,744.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $469.34 / $1,017.84 / $6,679.00
| Facility | | $469.34 | $1,017.84 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $630.12 / $794.01 / $1,096.04
| Professional | | $630.12 | $794.01 | $1,096.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $575.49 / $1,198.52 / $1,849.73
| Professional | | $575.49 | $1,198.52 | $1,849.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $728.79 / $728.79 / $728.79
| Professional | | $728.79 | $728.79 | $728.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,685.00 / $3,764.00 / $26,542.00
| Facility | | $1,685.00 | $3,764.00 | $26,542.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $578.36 / $978.01 / $4,643.39
| Professional | | $578.36 | $978.01 | $4,643.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,685.00 / $3,715.00 / $8,766.00
| Facility | | $1,685.00 | $3,715.00 | $8,766.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $567.53 / $786.46 / $1,708.32
| Professional | | $567.53 | $786.46 | $1,708.32 |