- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $413.70 / $650.21 / $7,724.00
| Facility | | $413.70 | $650.21 | $7,724.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $412.60 / $566.90 / $914.89
| Professional | | $412.60 | $566.90 | $914.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $331.35 / $331.35 / $507.50
| Professional | | $331.35 | $331.35 | $507.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $466.13 / $803.75 / $1,435.31
| Professional | | $466.13 | $803.75 | $1,435.31 |
- 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
- $462.01 / $673.31 / $1,281.00
| Professional | | $462.01 | $673.31 | $1,281.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $413.71 / $680.28 / $1,019.72
| Facility | | $413.71 | $680.28 | $1,019.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $579.00 / $744.00 / $754.00
| Professional | | $579.00 | $744.00 | $754.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.00 / $770.40 / $1,599.90
| Professional | | $3.00 | $770.40 | $1,599.90 |
- 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
- $494.34 / $733.63 / $1,428.17
| Professional | | $494.34 | $733.63 | $1,428.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,995.60 / $2,212.27 / $26,542.00
| Facility | | $1,995.60 | $2,212.27 | $26,542.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,178.56 / $4,247.43 / $4,891.64
| Professional | | $3,178.56 | $4,247.43 | $4,891.64 |