- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $238.33 / $3,245.96 / $10,034.00
| Facility | | $238.33 | $3,245.96 | $10,034.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.87 / $260.89 / $486.53
| Professional | | $234.87 | $260.89 | $486.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,506.47 / $1,657.11 / $2,812.07
| Facility | | $1,506.47 | $1,657.11 | $2,812.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $293.52 / $424.04 / $596.40
| Professional | | $293.52 | $424.04 | $596.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $280.11 / $1,432.77 / $2,702.90
| Facility | | $280.11 | $1,432.77 | $2,702.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $268.27 / $368.59 / $610.32
| Professional | | $268.27 | $368.59 | $610.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $238.33 / $321.93 / $451.88
| Facility | | $238.33 | $321.93 | $451.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $345.00 / $749.00 / $1,107.11
| Professional | | $345.00 | $749.00 | $1,107.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $304.80 / $366.30 / $539.40
| Professional | | $304.80 | $366.30 | $539.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $773.00 / $1,208.00 / $9,324.00
| Facility | | $773.00 | $1,208.00 | $9,324.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $206.98 / $287.32 / $640.64
| Professional | | $206.98 | $287.32 | $640.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,383.12 / $7,909.30 / $26,542.00
| Facility | | $1,383.12 | $7,909.30 | $26,542.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,806.96 / $1,806.96 / $2,108.40
| Professional | | $1,806.96 | $1,806.96 | $2,108.40 |