- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $166.95 / $1,455.25 / $6,915.00
| Facility | | $166.95 | $1,455.25 | $6,915.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.59 / $385.79 / $756.86
| Professional | | $104.59 | $385.79 | $756.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,311.30 / $1,311.30 / $1,330.43
| Facility | | $1,311.30 | $1,311.30 | $1,330.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $175.08 / $687.35 / $1,538.69
| Professional | | $175.08 | $687.35 | $1,538.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $530.04 / $530.04 / $1,215.60
| Facility | | $530.04 | $530.04 | $1,215.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $141.54 / $361.05 / $1,220.35
| Professional | | $141.54 | $361.05 | $1,220.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $126.95 / $394.00 / $1,053.31
| Facility | | $126.95 | $394.00 | $1,053.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $476.00 / $644.00 / $768.77
| Professional | | $476.00 | $644.00 | $768.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.00 / $492.40 / $1,645.00
| Professional | | $3.00 | $492.40 | $1,645.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $900.00 / $3,733.00 / $6,543.00
| Facility | | $900.00 | $3,733.00 | $6,543.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $365.66 / $666.21 / $1,169.84
| Professional | | $365.66 | $666.21 | $1,169.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $586.16 / $629.71 / $16,394.00
| Facility | | $586.16 | $629.71 | $16,394.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,385.32 / $5,686.46 / $5,686.46
| Professional | | $1,385.32 | $5,686.46 | $5,686.46 |