- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $320.20 / $1,927.82 / $3,469.00
| Facility | | $320.20 | $1,927.82 | $3,469.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $210.23 / $320.20 / $574.73
| Professional | | $210.23 | $320.20 | $574.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $387.42 / $1,981.00 / $7,929.30
| Facility | | $387.42 | $1,981.00 | $7,929.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $266.70 / $633.96 / $2,484.56
| Professional | | $266.70 | $633.96 | $2,484.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $493.39 / $682.03 / $1,059.41
| Professional | | $493.39 | $682.03 | $1,059.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $680.00 / $748.00 / $3,111.82
| Facility | | $680.00 | $748.00 | $3,111.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $254.14 / $549.05 / $1,208.08
| Professional | | $254.14 | $549.05 | $1,208.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $168.26 / $529.20 / $6,679.00
| Facility | | $168.26 | $529.20 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $397.34 / $510.30 / $737.10
| Professional | | $397.34 | $510.30 | $737.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $425.98 / $840.88 / $1,113.98
| Professional | | $425.98 | $840.88 | $1,113.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $2,575.00 / $7,929.30
| Facility | | $55.00 | $2,575.00 | $7,929.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $315.00 / $660.86 / $2,484.56
| Professional | | $315.00 | $660.86 | $2,484.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,061.00 / $3,715.00 / $8,766.00
| Facility | | $1,061.00 | $3,715.00 | $8,766.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $307.91 / $485.64 / $1,302.53
| Professional | | $307.91 | $485.64 | $1,302.53 |