- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $241.27 / $2,622.63 / $8,294.00
| Facility | | $241.27 | $2,622.63 | $8,294.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $226.01 / $531.63 / $1,680.80
| Professional | | $226.01 | $531.63 | $1,680.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $207.44 / $809.50 / $1,507.09
| Professional | | $207.44 | $809.50 | $1,507.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $247.46 / $247.46 / $778.00
| Professional | | $247.46 | $247.46 | $778.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $359.66 / $359.66 / $359.66
| Facility | | $359.66 | $359.66 | $359.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $242.39 / $531.54 / $1,877.82
| Professional | | $242.39 | $531.54 | $1,877.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $961.09 / $1,153.30 / $1,413.36
| Professional | | $961.09 | $1,153.30 | $1,413.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $250.09 / $561.88 / $1,918.53
| Facility | | $250.09 | $561.88 | $1,918.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,384.00 / $1,623.00 / $2,096.00
| Professional | | $1,384.00 | $1,623.00 | $2,096.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $226.09 / $317.49 / $534.48
| Facility | | $226.09 | $317.49 | $534.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $857.03 / $1,493.22 / $2,470.40
| Professional | | $857.03 | $1,493.22 | $2,470.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $296.00 / $1,148.00 / $2,364.00
| Facility | | $296.00 | $1,148.00 | $2,364.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $878.66 / $1,477.60 / $2,306.25
| Professional | | $878.66 | $1,477.60 | $2,306.25 |