- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $235.95 / $1,486.00 / $3,398.55
| Facility | | $235.95 | $1,486.00 | $3,398.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $257.64 / $342.56 / $855.17
| Professional | | $257.64 | $342.56 | $855.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $771.76 / $2,854.00 / $9,039.00
| Facility | | $771.76 | $2,854.00 | $9,039.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $291.49 / $587.79 / $2,321.19
| Professional | | $291.49 | $587.79 | $2,321.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $376.01 / $488.81 / $862.57
| Facility | | $376.01 | $488.81 | $862.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $460.52 / $674.90 / $956.36
| Professional | | $460.52 | $674.90 | $956.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.81 / $579.55 / $1,187.29
| Professional | | $354.81 | $579.55 | $1,187.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $318.44 / $685.62 / $6,679.00
| Facility | | $318.44 | $685.62 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $427.34 / $535.32 / $738.95
| Professional | | $427.34 | $535.32 | $738.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $395.26 / $813.17 / $1,187.44
| Professional | | $395.26 | $813.17 | $1,187.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,899.73 / $2,899.73 / $7,475.82
| Facility | | $2,899.73 | $2,899.73 | $7,475.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,902.00 / $3,764.00 / $16,394.00
| Facility | | $1,902.00 | $3,764.00 | $16,394.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $412.22 / $734.34 / $2,796.00
| Professional | | $412.22 | $734.34 | $2,796.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,700.00 / $4,249.00 / $9,821.00
| Facility | | $1,700.00 | $4,249.00 | $9,821.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $329.51 / $536.38 / $1,030.51
| Professional | | $329.51 | $536.38 | $1,030.51 |