- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $602.56 / $912.01 / $7,943.28
| Facility | | $602.56 | $912.01 | $7,943.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $309.03 / $426.58 / $933.25
| Professional | | $309.03 | $426.58 | $933.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $389.05 / $794.33 / $1,122.02
| Professional | | $389.05 | $794.33 | $1,122.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $457.09 / $691.83 / $1,000.00
| Professional | | $457.09 | $691.83 | $1,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $407.38 / $588.84 / $6,025.60
| Facility | | $407.38 | $588.84 | $6,025.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $478.63 / $645.65 / $1,000.00
| Professional | | $478.63 | $645.65 | $1,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $562.34 / $776.25 / $812.83
| Facility | | $562.34 | $776.25 | $812.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $363.08 / $562.34 / $912.01
| Facility | | $363.08 | $562.34 | $912.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $79.43 / $724.44 / $1,023.29
| Professional | | $79.43 | $724.44 | $1,023.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,413.10 / $10,232.93 / $12,022.64
| Facility | | $7,413.10 | $10,232.93 | $12,022.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $588.84 / $776.25 / $1,047.13
| Professional | | $588.84 | $776.25 | $1,047.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,995.26 / $10,000.00 / $14,454.40
| Facility | | $1,995.26 | $10,000.00 | $14,454.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $407.38 / $707.95 / $1,071.52
| Professional | | $407.38 | $707.95 | $1,071.52 |