- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $489.67 / $1,181.00 / $7,439.00
| Facility | | $489.67 | $1,181.00 | $7,439.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $489.67 / $516.03 / $916.62
| Professional | | $489.67 | $516.03 | $916.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,457.61 / $1,457.61 / $1,478.88
| Facility | | $1,457.61 | $1,457.61 | $1,478.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $478.80 / $726.45 / $1,298.69
| Professional | | $478.80 | $726.45 | $1,298.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $530.04 / $530.04 / $1,587.44
| Facility | | $530.04 | $530.04 | $1,587.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $448.63 / $656.14 / $1,206.08
| Professional | | $448.63 | $656.14 | $1,206.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $467.00 / $538.64 / $894.05
| Facility | | $467.00 | $538.64 | $894.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $507.00 / $609.00 / $654.00
| Professional | | $507.00 | $609.00 | $654.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.00 / $676.20 / $1,287.80
| Professional | | $5.00 | $676.20 | $1,287.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,661.00 / $7,659.00 / $10,502.00
| Facility | | $1,661.00 | $7,659.00 | $10,502.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $408.53 / $561.61 / $1,182.95
| Professional | | $408.53 | $561.61 | $1,182.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,909.22 / $5,246.20 / $16,394.00
| Facility | | $2,909.22 | $5,246.20 | $16,394.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,589.52 / $3,589.52 / $4,570.58
| Professional | | $3,589.52 | $3,589.52 | $4,570.58 |