- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $378.73 / $7,119.04 / $20,928.72
| Facility | | $378.73 | $7,119.04 | $20,928.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $378.73 / $449.31 / $2,008.95
| Professional | | $378.73 | $449.31 | $2,008.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $370.15 / $370.15 / $370.15
| Professional | | $370.15 | $370.15 | $370.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,350.61 / $4,406.97 / $8,524.51
| Facility | | $3,350.61 | $4,406.97 | $8,524.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $372.08 / $627.89 / $845.65
| Professional | | $372.08 | $627.89 | $845.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $193.40 / $193.40 / $193.40
| Facility | | $193.40 | $193.40 | $193.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $749.00 / $942.71 / $1,273.45
| Professional | | $749.00 | $942.71 | $1,273.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $378.73 / $662.78 / $1,277.16
| Facility | | $378.73 | $662.78 | $1,277.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $520.59 / $926.48 / $3,082.64
| Professional | | $520.59 | $926.48 | $3,082.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $212.73 / $938.14 / $1,273.45
| Facility | | $212.73 | $938.14 | $1,273.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $796.76 / $1,047.24 / $1,284.77
| Professional | | $796.76 | $1,047.24 | $1,284.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,031.00 / $1,775.00 / $4,406.00
| Facility | | $1,031.00 | $1,775.00 | $4,406.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $520.59 / $889.00 / $1,121.26
| Professional | | $520.59 | $889.00 | $1,121.26 |