- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $527.35 / $3,214.81 / $9,597.87
| Facility | | $527.35 | $3,214.81 | $9,597.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $483.06 / $554.46 / $1,235.46
| Professional | | $483.06 | $554.46 | $1,235.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.91 / $551.80 / $554.36
| Professional | | $275.91 | $551.80 | $554.36 |
- 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
- $549.91 / $794.31 / $1,401.31
| Professional | | $549.91 | $794.31 | $1,401.31 |
- 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
- $527.59 / $727.18 / $1,313.44
| Professional | | $527.59 | $727.18 | $1,313.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $513.39 / $667.00 / $1,041.00
| Facility | | $513.39 | $667.00 | $1,041.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $507.00 / $655.00 / $691.00
| Professional | | $507.00 | $655.00 | $691.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,743.93 / $8,743.93 / $8,743.93
| Facility | | $8,743.93 | $8,743.93 | $8,743.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $704.20 / $809.42 / $886.01
| Professional | | $704.20 | $809.42 | $886.01 |
- 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
- $439.70 / $611.55 / $1,273.21
| Professional | | $439.70 | $611.55 | $1,273.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,993.00 / $4,017.35 / $16,394.00
| Facility | | $1,993.00 | $4,017.35 | $16,394.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,522.02 / $4,522.02 / $4,581.30
| Professional | | $4,522.02 | $4,522.02 | $4,581.30 |