- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $460.20 / $2,747.00 / $7,920.26
| Facility | | $460.20 | $2,747.00 | $7,920.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $206.17 / $312.83 / $849.00
| Professional | | $206.17 | $312.83 | $849.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,664.70 / $1,664.70 / $1,664.70
| Facility | | $1,664.70 | $1,664.70 | $1,664.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $273.61 / $463.54 / $666.78
| Professional | | $273.61 | $463.54 | $666.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $362.72 / $476.28 / $578.50
| Professional | | $362.72 | $476.28 | $578.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $252.31 / $442.67 / $642.37
| Facility | | $252.31 | $442.67 | $642.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $351.90 / $422.22 / $686.64
| Professional | | $351.90 | $422.22 | $686.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $329.94 / $441.85 / $468.33
| Facility | | $329.94 | $441.85 | $468.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $264.58 / $480.91 / $642.37
| Facility | | $264.58 | $480.91 | $642.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $395.58 / $506.78 / $664.05
| Professional | | $395.58 | $506.78 | $664.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,208.47 / $1,208.47 / $1,208.47
| Facility | | $1,208.47 | $1,208.47 | $1,208.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $428.68 / $545.57 / $660.75
| Professional | | $428.68 | $545.57 | $660.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,345.00 / $7,664.00 / $31,303.00
| Facility | | $1,345.00 | $7,664.00 | $31,303.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $350.37 / $493.67 / $727.47
| Professional | | $350.37 | $493.67 | $727.47 |