- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $749.22 / $2,747.00 / $7,920.26
| Facility | | $749.22 | $2,747.00 | $7,920.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $335.96 / $509.40 / $1,429.25
| Professional | | $335.96 | $509.40 | $1,429.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,664.70 / $1,664.70 / $1,664.70
| Facility | | $1,664.70 | $1,664.70 | $1,664.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $445.81 / $752.62 / $1,086.68
| Professional | | $445.81 | $752.62 | $1,086.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $590.94 / $775.95 / $942.55
| Professional | | $590.94 | $775.95 | $942.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $416.06 / $715.81 / $1,050.56
| Facility | | $416.06 | $715.81 | $1,050.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $585.00 / $692.90 / $1,114.95
| Professional | | $585.00 | $692.90 | $1,114.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $541.66 / $719.86 / $760.45
| Facility | | $541.66 | $719.86 | $760.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $430.99 / $789.98 / $1,050.56
| Facility | | $430.99 | $789.98 | $1,050.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $644.53 / $824.33 / $1,080.15
| Professional | | $644.53 | $824.33 | $1,080.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,989.27 / $1,989.27 / $1,989.27
| Facility | | $1,989.27 | $1,989.27 | $1,989.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $696.83 / $885.87 / $1,075.04
| Professional | | $696.83 | $885.87 | $1,075.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,345.00 / $7,664.00 / $31,303.00
| Facility | | $1,345.00 | $7,664.00 | $31,303.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $560.49 / $782.61 / $1,182.54
| Professional | | $560.49 | $782.61 | $1,182.54 |