- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $559.40 / $3,912.00 / $8,713.85
| Facility | | $559.40 | $3,912.00 | $8,713.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $291.49 / $843.55 / $1,521.35
| Professional | | $291.49 | $843.55 | $1,521.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $265.38 / $834.43 / $1,611.00
| Professional | | $265.38 | $834.43 | $1,611.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $306.27 / $314.60 / $778.00
| Professional | | $306.27 | $314.60 | $778.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $459.52 / $459.52 / $459.52
| Facility | | $459.52 | $459.52 | $459.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $293.16 / $690.94 / $2,031.07
| Professional | | $293.16 | $690.94 | $2,031.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $987.51 / $1,185.02 / $1,452.23
| Professional | | $987.51 | $1,185.02 | $1,452.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $319.16 / $717.73 / $2,043.78
| Facility | | $319.16 | $717.73 | $2,043.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,430.00 / $1,684.99 / $2,364.00
| Professional | | $1,430.00 | $1,684.99 | $2,364.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $270.64 / $377.58 / $653.53
| Facility | | $270.64 | $377.58 | $653.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $923.02 / $1,618.87 / $2,576.51
| Professional | | $923.02 | $1,618.87 | $2,576.51 |
- 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
- $940.35 / $1,561.57 / $2,530.71
| Professional | | $940.35 | $1,561.57 | $2,530.71 |