- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $285.77 / $4,078.55 / $4,311.00
| Facility | | $285.77 | $4,078.55 | $4,311.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $178.54 / $484.33 / $688.53
| Professional | | $178.54 | $484.33 | $688.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $649.41 / $714.35 / $1,212.23
| Facility | | $649.41 | $714.35 | $1,212.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $300.74 / $879.26 / $1,521.96
| Professional | | $300.74 | $879.26 | $1,521.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $323.44 / $869.75 / $1,640.78
| Facility | | $323.44 | $869.75 | $1,640.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $230.51 / $580.14 / $1,362.38
| Professional | | $230.51 | $580.14 | $1,362.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $178.54 / $559.10 / $817.28
| Facility | | $178.54 | $559.10 | $817.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $400.00 / $676.00 / $1,393.20
| Professional | | $400.00 | $676.00 | $1,393.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $207.56 / $555.72 / $1,230.80
| Professional | | $207.56 | $555.72 | $1,230.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $393.00 / $650.00 / $4,824.00
| Facility | | $393.00 | $650.00 | $4,824.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $522.15 / $728.66 / $1,414.16
| Professional | | $522.15 | $728.66 | $1,414.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $1,030.90 / $1,030.90
| Facility | | $55.00 | $1,030.90 | $1,030.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,024.16 / $3,876.64 / $4,538.39
| Professional | | $2,024.16 | $3,876.64 | $4,538.39 |