- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $345.47 / $4,158.45 / $7,993.00
| Facility | | $345.47 | $4,158.45 | $7,993.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $282.50 / $437.98 / $781.81
| Professional | | $282.50 | $437.98 | $781.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $398.19 / $546.79 / $546.79
| Professional | | $398.19 | $546.79 | $546.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $345.73 / $578.22 / $1,142.99
| Professional | | $345.73 | $578.22 | $1,142.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $515.00 / $1,362.98 / $2,709.73
| Facility | | $515.00 | $1,362.98 | $2,709.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $332.65 / $549.60 / $1,020.14
| Professional | | $332.65 | $549.60 | $1,020.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $314.06 / $517.45 / $771.22
| Facility | | $314.06 | $517.45 | $771.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $579.00 / $611.00 / $1,125.35
| Professional | | $579.00 | $611.00 | $1,125.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $451.78 / $524.20 / $1,021.90
| Professional | | $451.78 | $524.20 | $1,021.90 |
- 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
- $371.00 / $516.12 / $1,113.53
| Professional | | $371.00 | $516.12 | $1,113.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,210.76 / $2,210.76 / $26,542.00
| Facility | | $2,210.76 | $2,210.76 | $26,542.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,321.67 / $3,452.56 / $4,094.93
| Professional | | $2,321.67 | $3,452.56 | $4,094.93 |