- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $440.08 / $5,611.88 / $8,413.00
| Facility | | $440.08 | $5,611.88 | $8,413.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $393.83 / $456.33 / $891.12
| Professional | | $393.83 | $456.33 | $891.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,794.89 / $1,794.89 / $1,821.08
| Facility | | $1,794.89 | $1,794.89 | $1,821.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $533.09 / $747.02 / $1,263.26
| Professional | | $533.09 | $747.02 | $1,263.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $606.10 / $606.10 / $2,062.80
| Facility | | $606.10 | $606.10 | $2,062.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $500.47 / $656.28 / $1,160.54
| Professional | | $500.47 | $656.28 | $1,160.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $440.08 / $574.10 / $844.01
| Facility | | $440.08 | $574.10 | $844.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $573.00 / $573.00 / $586.00
| Professional | | $573.00 | $573.00 | $586.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.00 / $588.90 / $1,256.50
| Professional | | $3.00 | $588.90 | $1,256.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,661.00 / $7,659.00 / $10,502.00
| Facility | | $1,661.00 | $7,659.00 | $10,502.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $400.94 / $590.98 / $1,111.59
| Professional | | $400.94 | $590.98 | $1,111.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $5,950.27 / $6,817.20
| Facility | | $55.00 | $5,950.27 | $6,817.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,319.84 / $3,798.08 / $3,798.08
| Professional | | $3,319.84 | $3,798.08 | $3,798.08 |