- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $352.92 / $1,245.00 / $8,934.20
| Facility | | $352.92 | $1,245.00 | $8,934.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $330.25 / $501.12 / $854.07
| Professional | | $330.25 | $501.12 | $854.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,704.83 / $1,704.83 / $1,729.70
| Facility | | $1,704.83 | $1,704.83 | $1,729.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $441.19 / $717.07 / $1,325.15
| Professional | | $441.19 | $717.07 | $1,325.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $606.10 / $606.10 / $6,025.59
| Facility | | $606.10 | $606.10 | $6,025.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $416.19 / $625.34 / $1,168.88
| Professional | | $416.19 | $625.34 | $1,168.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $359.32 / $630.39 / $943.00
| Facility | | $359.32 | $630.39 | $943.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $579.00 / $690.00 / $707.00
| Professional | | $579.00 | $690.00 | $707.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.00 / $723.80 / $1,450.20
| Professional | | $3.00 | $723.80 | $1,450.20 |
- 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
- $455.59 / $629.84 / $1,329.30
| Professional | | $455.59 | $629.84 | $1,329.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,705.44 / $1,876.87 / $26,542.00
| Facility | | $1,705.44 | $1,876.87 | $26,542.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,714.64 / $3,976.72 / $4,606.95
| Professional | | $2,714.64 | $3,976.72 | $4,606.95 |