- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $268.70 / $1,245.00 / $7,278.00
| Facility | | $268.70 | $1,245.00 | $7,278.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $268.70 / $284.69 / $489.44
| Professional | | $268.70 | $284.69 | $489.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,763.82 / $1,940.20 / $3,292.46
| Facility | | $1,763.82 | $1,940.20 | $3,292.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $323.76 / $557.54 / $901.05
| Professional | | $323.76 | $557.54 | $901.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $453.24 / $3,091.78 / $6,146.74
| Facility | | $453.24 | $3,091.78 | $6,146.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $329.89 / $471.27 / $809.48
| Professional | | $329.89 | $471.27 | $809.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $268.70 / $417.00 / $600.71
| Facility | | $268.70 | $417.00 | $600.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $431.54 / $534.00 / $1,247.35
| Professional | | $431.54 | $534.00 | $1,247.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $382.10 / $453.50 / $657.00
| Professional | | $382.10 | $453.50 | $657.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $902.00 / $1,557.00 / $11,999.00
| Facility | | $902.00 | $1,557.00 | $11,999.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $268.00 / $373.42 / $721.03
| Professional | | $268.00 | $373.42 | $721.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,266.25 / $16,394.00 / $17,986.75
| Facility | | $1,266.25 | $16,394.00 | $17,986.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,054.26 / $2,054.26 / $2,269.88
| Professional | | $2,054.26 | $2,054.26 | $2,269.88 |