- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $426.94 / $3,819.00 / $7,278.00
| Facility | | $426.94 | $3,819.00 | $7,278.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $285.54 / $426.95 / $922.47
| Professional | | $285.54 | $426.95 | $922.47 |
- 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
- $359.50 / $593.17 / $1,028.17
| Professional | | $359.50 | $593.17 | $1,028.17 |
- 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
- $347.28 / $512.89 / $913.74
| Professional | | $347.28 | $512.89 | $913.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $299.77 / $493.29 / $740.57
| Facility | | $299.77 | $493.29 | $740.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $493.29 / $514.00 / $600.00
| Professional | | $493.29 | $514.00 | $600.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.00 / $573.60 / $1,135.80
| Professional | | $5.00 | $573.60 | $1,135.80 |
- 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
- $354.36 / $504.52 / $1,002.76
| Professional | | $354.36 | $504.52 | $1,002.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,132.16 / $2,132.16 / $16,394.00
| Facility | | $2,132.16 | $2,132.16 | $16,394.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,235.84 / $3,106.64 / $3,696.38
| Professional | | $2,235.84 | $3,106.64 | $3,696.38 |