- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $379.39 / $609.27 / $7,439.00
| Facility | | $379.39 | $609.27 | $7,439.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $291.33 / $379.39 / $384.31
| Professional | | $291.33 | $379.39 | $384.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,603.53 / $2,603.53 / $2,641.52
| Facility | | $2,603.53 | $2,603.53 | $2,641.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $353.10 / $468.70 / $800.86
| Professional | | $353.10 | $468.70 | $800.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,710.28 / $2,710.28 / $2,710.28
| Facility | | $2,710.28 | $2,710.28 | $2,710.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,623.59 / $1,623.59 / $1,623.59
| Professional | | $1,623.59 | $1,623.59 | $1,623.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $266.51 / $320.00 / $455.27
| Facility | | $266.51 | $320.00 | $455.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $266.51 / $266.51 / $266.51
| Professional | | $266.51 | $266.51 | $266.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $407.50 / $407.50 / $407.50
| Professional | | $407.50 | $407.50 | $407.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,248.00 / $9,541.00 / $14,589.00
| Facility | | $2,248.00 | $9,541.00 | $14,589.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $244.67 / $347.96 / $700.89
| Professional | | $244.67 | $347.96 | $700.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,136.59 / $7,817.95 / $8,957.00
| Facility | | $1,136.59 | $7,817.95 | $8,957.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,419.98 / $2,619.44 / $2,619.44
| Professional | | $2,419.98 | $2,619.44 | $2,619.44 |