- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $813.75 / $2,663.12 / $4,524.72
| Facility | | $813.75 | $2,663.12 | $4,524.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $252.52 / $339.36 / $1,417.31
| Professional | | $252.52 | $339.36 | $1,417.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $580.47 / $3,997.00 / $12,379.00
| Facility | | $580.47 | $3,997.00 | $12,379.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $241.02 / $480.22 / $2,104.00
| Professional | | $241.02 | $480.22 | $2,104.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $325.11 / $489.30 / $886.81
| Professional | | $325.11 | $489.30 | $886.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $243.94 / $508.00 / $6,679.00
| Facility | | $243.94 | $508.00 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.38 / $278.31 / $442.45
| Professional | | $147.38 | $278.31 | $442.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $299.01 / $596.35 / $899.24
| Professional | | $299.01 | $596.35 | $899.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,977.42 / $3,863.50 / $5,954.84
| Facility | | $2,977.42 | $3,863.50 | $5,954.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $368.48 / $413.77 / $538.52
| Professional | | $368.48 | $413.77 | $538.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,343.70 / $4,525.00 / $16,394.00
| Facility | | $1,343.70 | $4,525.00 | $16,394.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $277.95 / $508.00 / $2,104.00
| Professional | | $277.95 | $508.00 | $2,104.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,902.00 / $3,764.00 / $8,766.00
| Facility | | $1,902.00 | $3,764.00 | $8,766.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $274.74 / $382.32 / $887.16
| Professional | | $274.74 | $382.32 | $887.16 |