- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $428.13 / $6,048.00 / $16,762.57
| Facility | | $428.13 | $6,048.00 | $16,762.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $237.95 / $397.59 / $944.90
| Professional | | $237.95 | $397.59 | $944.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $389.72 / $389.72 / $389.72
| Professional | | $389.72 | $389.72 | $389.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,442.56 / $3,212.63 / $6,214.26
| Facility | | $2,442.56 | $3,212.63 | $6,214.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $251.18 / $476.50 / $794.19
| Professional | | $251.18 | $476.50 | $794.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $349.70 / $789.79 / $1,234.69
| Professional | | $349.70 | $789.79 | $1,234.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $333.34 / $650.50 / $1,775.00
| Facility | | $333.34 | $650.50 | $1,775.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $498.04 / $859.81 / $1,914.08
| Professional | | $498.04 | $859.81 | $1,914.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $537.54 / $720.76 / $1,148.14
| Facility | | $537.54 | $720.76 | $1,148.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $520.36 / $782.13 / $1,148.14
| Professional | | $520.36 | $782.13 | $1,148.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $270.14 / $453.60 / $847.22
| Professional | | $270.14 | $453.60 | $847.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,031.00 / $1,775.00 / $4,406.00
| Facility | | $1,031.00 | $1,775.00 | $4,406.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $510.14 / $910.96 / $1,005.90
| Professional | | $510.14 | $910.96 | $1,005.90 |