- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $516.61 / $3,229.79 / $7,835.88
| Facility | | $516.61 | $3,229.79 | $7,835.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $305.64 / $601.70 / $1,424.05
| Professional | | $305.64 | $601.70 | $1,424.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $223.71 / $447.42 / $520.99
| Professional | | $223.71 | $447.42 | $520.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $395.95 / $706.24 / $1,493.20
| Professional | | $395.95 | $706.24 | $1,493.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $606.10 / $606.10 / $1,438.74
| Facility | | $606.10 | $606.10 | $1,438.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.77 / $665.54 / $1,268.71
| Professional | | $354.77 | $665.54 | $1,268.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $308.60 / $660.74 / $1,386.00
| Facility | | $308.60 | $660.74 | $1,386.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $579.00 / $708.00 / $787.00
| Professional | | $579.00 | $708.00 | $787.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,186.31 / $2,186.31 / $2,186.31
| Facility | | $2,186.31 | $2,186.31 | $2,186.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.00 / $818.50 / $1,587.50
| Professional | | $3.00 | $818.50 | $1,587.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,064.00 / $3,445.00 / $6,097.00
| Facility | | $1,064.00 | $3,445.00 | $6,097.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $474.73 / $699.61 / $1,419.60
| Professional | | $474.73 | $699.61 | $1,419.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,489.88 / $1,670.72 / $26,542.00
| Facility | | $1,489.88 | $1,670.72 | $26,542.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,345.12 / $4,387.43 / $5,195.78
| Professional | | $2,345.12 | $4,387.43 | $5,195.78 |