- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $494.38 / $2,998.00 / $8,294.00
| Facility | | $494.38 | $2,998.00 | $8,294.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $287.73 / $481.67 / $728.90
| Professional | | $287.73 | $481.67 | $728.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,060.00 / $3,693.00 / $4,290.00
| Facility | | $3,060.00 | $3,693.00 | $4,290.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $266.43 / $436.05 / $651.16
| Professional | | $266.43 | $436.05 | $651.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $296.38 / $429.19 / $3,774.00
| Professional | | $296.38 | $429.19 | $3,774.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $302.70 / $484.20 / $879.22
| Professional | | $302.70 | $484.20 | $879.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $428.37 / $514.04 / $633.99
| Professional | | $428.37 | $514.04 | $633.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $311.45 / $521.52 / $839.88
| Facility | | $311.45 | $521.52 | $839.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $513.00 / $631.73 / $873.00
| Professional | | $513.00 | $631.73 | $873.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $282.66 / $374.78 / $3,512.00
| Facility | | $282.66 | $374.78 | $3,512.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $446.85 / $633.66 / $3,512.00
| Professional | | $446.85 | $633.66 | $3,512.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,349.00 / $7,061.00 / $12,739.00
| Facility | | $4,349.00 | $7,061.00 | $12,739.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $400.25 / $672.74 / $1,011.50
| Professional | | $400.25 | $672.74 | $1,011.50 |