- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $558.17 / $6,870.95 / $7,535.00
| Facility | | $558.17 | $6,870.95 | $7,535.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $329.74 / $433.07 / $797.12
| Professional | | $329.74 | $433.07 | $797.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $149.07 / $149.07 / $298.14
| Professional | | $149.07 | $149.07 | $298.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,794.89 / $1,794.89 / $1,821.08
| Facility | | $1,794.89 | $1,794.89 | $1,821.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $549.20 / $897.53 / $1,467.59
| Professional | | $549.20 | $897.53 | $1,467.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $606.10 / $606.10 / $2,062.80
| Facility | | $606.10 | $606.10 | $2,062.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $409.53 / $720.29 / $1,186.10
| Professional | | $409.53 | $720.29 | $1,186.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $339.20 / $708.00 / $995.78
| Facility | | $339.20 | $708.00 | $995.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $436.00 / $443.00 / $772.44
| Professional | | $436.00 | $443.00 | $772.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.00 / $479.41 / $1,666.60
| Professional | | $5.00 | $479.41 | $1,666.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,661.00 / $7,659.00 / $10,502.00
| Facility | | $1,661.00 | $7,659.00 | $10,502.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $316.18 / $640.98 / $1,079.66
| Professional | | $316.18 | $640.98 | $1,079.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,896.96 / $6,817.20 / $26,542.00
| Facility | | $1,896.96 | $6,817.20 | $26,542.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,100.72 / $3,437.03 / $3,437.03
| Professional | | $3,100.72 | $3,437.03 | $3,437.03 |