- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $331.68 / $2,502.31 / $5,681.00
| Facility | | $331.68 | $2,502.31 | $5,681.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $263.92 / $536.86 / $3,948.85
| Professional | | $263.92 | $536.86 | $3,948.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $239.47 / $321.87 / $552.79
| Professional | | $239.47 | $321.87 | $552.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $609.37 / $1,036.73 / $8,092.33
| Professional | | $609.37 | $1,036.73 | $8,092.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $454.13 / $650.35 / $1,226.89
| Facility | | $454.13 | $650.35 | $1,226.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $373.80 / $736.83 / $5,709.34
| Professional | | $373.80 | $736.83 | $5,709.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $263.92 / $748.57 / $3,396.18
| Facility | | $263.92 | $748.57 | $3,396.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $470.03 / $708.93 / $7,324.58
| Professional | | $470.03 | $708.93 | $7,324.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,213.13 / $2,213.13 / $2,213.13
| Facility | | $2,213.13 | $2,213.13 | $2,213.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $306.54 / $766.35 / $5,612.77
| Professional | | $306.54 | $766.35 | $5,612.77 |
- 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
- $539.90 / $2,393.46 / $5,678.03
| Professional | | $539.90 | $2,393.46 | $5,678.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $3,880.05 / $3,880.05
| Facility | | $55.00 | $3,880.05 | $3,880.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8,697.96 / $16,791.79 / $19,487.48
| Professional | | $8,697.96 | $16,791.79 | $19,487.48 |