- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $284.06 / $1,426.00 / $2,072.00
| Facility | | $284.06 | $1,426.00 | $2,072.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $257.81 / $1,217.90 / $1,451.27
| Professional | | $257.81 | $1,217.90 | $1,451.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $627.88 / $1,174.39 / $1,174.39
| Facility | | $627.88 | $1,174.39 | $1,174.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $913.97 / $1,368.65 / $2,313.19
| Professional | | $913.97 | $1,368.65 | $2,313.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,437.15 / $1,671.57 / $2,131.96
| Facility | | $1,437.15 | $1,671.57 | $2,131.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $345.14 / $567.76 / $766.73
| Professional | | $345.14 | $567.76 | $766.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $141.47 / $8,062.55 / $13,588.20
| Facility | | $141.47 | $8,062.55 | $13,588.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $83.43 / $4,618.00 / $9,239.00
| Facility | | $83.43 | $4,618.00 | $9,239.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $94.37 / $291.95 / $454.50
| Professional | | $94.37 | $291.95 | $454.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $266.24 / $503.75 / $663.10
| Professional | | $266.24 | $503.75 | $663.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $627.88 / $1,174.39 / $1,174.39
| Facility | | $627.88 | $1,174.39 | $1,174.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $912.43 / $1,368.65 / $2,313.19
| Professional | | $912.43 | $1,368.65 | $2,313.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $844.00 / $1,159.60 / $2,313.19
| Professional | | $844.00 | $1,159.60 | $2,313.19 |