- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $564.41 / $2,514.00 / $7,495.00
| Facility | | $564.41 | $2,514.00 | $7,495.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $347.62 / $491.07 / $668.07
| Professional | | $347.62 | $491.07 | $668.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,964.47 / $3,980.30 / $7,622.13
| Facility | | $1,964.47 | $3,980.30 | $7,622.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $332.61 / $469.09 / $676.50
| Professional | | $332.61 | $469.09 | $676.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $318.75 / $318.75 / $502.24
| Facility | | $318.75 | $318.75 | $502.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $376.10 / $534.97 / $781.08
| Professional | | $376.10 | $534.97 | $781.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,484.71 / $16,394.00 / $16,394.00
| Facility | | $2,484.71 | $16,394.00 | $16,394.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,621.76 / $3,645.28 / $4,269.53
| Professional | | $2,621.76 | $3,645.28 | $4,269.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $347.62 / $496.19 / $731.51
| Facility | | $347.62 | $496.19 | $731.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $441.53 / $656.99 / $915.10
| Professional | | $441.53 | $656.99 | $915.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $347.62 / $497.10 / $739.61
| Facility | | $347.62 | $497.10 | $739.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $383.58 / $562.29 / $909.00
| Professional | | $383.58 | $562.29 | $909.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $597.00 / $2,064.00 / $4,554.00
| Facility | | $597.00 | $2,064.00 | $4,554.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $384.89 / $513.19 / $769.79
| Professional | | $384.89 | $513.19 | $769.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $419.90 / $473.20 / $662.48
| Professional | | $419.90 | $473.20 | $662.48 |