- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $850.09 / $2,747.00 / $7,920.26
| Facility | | $850.09 | $2,747.00 | $7,920.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $388.62 / $587.24 / $1,607.88
| Professional | | $388.62 | $587.24 | $1,607.88 |
- 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
- $468.02 / $834.06 / $1,195.23
| Professional | | $468.02 | $834.06 | $1,195.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $679.98 / $892.88 / $1,095.91
| Professional | | $679.98 | $892.88 | $1,095.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $439.90 / $766.52 / $1,351.38
| Facility | | $439.90 | $766.52 | $1,351.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $652.79 / $775.62 / $1,274.07
| Professional | | $652.79 | $775.62 | $1,274.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $558.17 / $828.34 / $890.43
| Facility | | $558.17 | $828.34 | $890.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $467.46 / $880.00 / $1,351.38
| Facility | | $467.46 | $880.00 | $1,351.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $724.07 / $940.33 / $1,224.91
| Professional | | $724.07 | $940.33 | $1,224.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,219.92 / $2,219.92 / $2,219.92
| Facility | | $2,219.92 | $2,219.92 | $2,219.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $793.39 / $1,012.31 / $1,222.27
| Professional | | $793.39 | $1,012.31 | $1,222.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,472.00 / $4,880.00 / $7,233.00
| Facility | | $1,472.00 | $4,880.00 | $7,233.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $616.41 / $930.93 / $1,372.41
| Professional | | $616.41 | $930.93 | $1,372.41 |