- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $230.75 / $1,029.83 / $5,743.00
| Facility | | $230.75 | $1,029.83 | $5,743.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $134.22 / $676.00 / $1,109.46
| Professional | | $134.22 | $676.00 | $1,109.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,735.00 / $2,390.00 / $2,954.00
| Facility | | $1,735.00 | $2,390.00 | $2,954.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $132.61 / $603.14 / $1,087.19
| Professional | | $132.61 | $603.14 | $1,087.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $137.21 / $144.44 / $290.33
| Professional | | $137.21 | $144.44 | $290.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $230.35 / $509.74 / $617.00
| Facility | | $230.35 | $509.74 | $617.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.54 / $354.79 / $1,488.34
| Professional | | $144.54 | $354.79 | $1,488.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $670.28 / $841.99 / $1,523.35
| Professional | | $670.28 | $841.99 | $1,523.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $152.40 / $836.63 / $1,519.72
| Facility | | $152.40 | $836.63 | $1,519.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,047.00 / $1,273.00 / $1,612.00
| Professional | | $1,047.00 | $1,273.00 | $1,612.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $143.22 / $185.34 / $334.34
| Facility | | $143.22 | $185.34 | $334.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $894.43 / $1,154.93 / $1,961.06
| Professional | | $894.43 | $1,154.93 | $1,961.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $516.00 / $2,441.00 / $5,226.00
| Facility | | $516.00 | $2,441.00 | $5,226.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $712.23 / $1,167.75 / $1,714.28
| Professional | | $712.23 | $1,167.75 | $1,714.28 |