- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $376.17 / $1,909.50 / $7,278.00
| Facility | | $376.17 | $1,909.50 | $7,278.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $207.48 / $376.17 / $749.62
| Professional | | $207.48 | $376.17 | $749.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $159.86 / $159.86 / $159.86
| Professional | | $159.86 | $159.86 | $159.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,479.15 / $1,627.07 / $2,761.08
| Facility | | $1,479.15 | $1,627.07 | $2,761.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $284.66 / $448.31 / $777.87
| Professional | | $284.66 | $448.31 | $777.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $338.41 / $1,436.38 / $2,709.73
| Facility | | $338.41 | $1,436.38 | $2,709.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $244.58 / $421.73 / $797.17
| Professional | | $244.58 | $421.73 | $797.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $284.58 / $362.00 / $567.83
| Facility | | $284.58 | $362.00 | $567.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $378.00 / $400.00 / $1,125.35
| Professional | | $378.00 | $400.00 | $1,125.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $305.89 / $539.97 / $797.90
| Professional | | $305.89 | $539.97 | $797.90 |
- 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
- $266.38 / $385.13 / $913.76
| Professional | | $266.38 | $385.13 | $913.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,123.88 / $7,929.30 / $12,000.00
| Facility | | $2,123.88 | $7,929.30 | $12,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,771.04 / $2,771.04 / $3,246.98
| Professional | | $2,771.04 | $2,771.04 | $3,246.98 |