- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $460.44 / $1,020.00 / $8,413.00
| Facility | | $460.44 | $1,020.00 | $8,413.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $394.98 / $464.23 / $828.77
| Professional | | $394.98 | $464.23 | $828.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,326.31 / $1,326.31 / $1,345.66
| Facility | | $1,326.31 | $1,326.31 | $1,345.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $521.88 / $725.65 / $1,213.42
| Professional | | $521.88 | $725.65 | $1,213.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $606.10 / $606.10 / $2,710.28
| Facility | | $606.10 | $606.10 | $2,710.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $490.03 / $663.53 / $1,153.26
| Professional | | $490.03 | $663.53 | $1,153.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $460.44 / $545.86 / $1,040.58
| Facility | | $460.44 | $545.86 | $1,040.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $545.86 / $573.00 / $619.00
| Professional | | $545.86 | $573.00 | $619.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.00 / $632.70 / $1,228.90
| Professional | | $3.00 | $632.70 | $1,228.90 |
- 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
- $388.69 / $542.04 / $1,125.50
| Professional | | $388.69 | $542.04 | $1,125.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,785.88 / $8,957.00 / $26,542.00
| Facility | | $1,785.88 | $8,957.00 | $26,542.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,367.00 / $4,865.33 / $4,865.33
| Professional | | $4,367.00 | $4,865.33 | $4,865.33 |