- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $314.00 / $1,400.44 / $2,443.02
| Facility | | $314.00 | $1,400.44 | $2,443.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $297.30 / $314.00 / $881.78
| Professional | | $297.30 | $314.00 | $881.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $592.28 / $1,049.92 / $3,807.70
| Facility | | $592.28 | $1,049.92 | $3,807.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $240.49 / $706.93 / $1,673.94
| Professional | | $240.49 | $706.93 | $1,673.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $653.10 / $1,758.09 / $3,184.95
| Facility | | $653.10 | $1,758.09 | $3,184.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $421.66 / $753.52 / $793.60
| Professional | | $421.66 | $753.52 | $793.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $364.37 / $647.60 / $1,254.85
| Facility | | $364.37 | $647.60 | $1,254.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $217.27 / $482.09 / $1,221.45
| Professional | | $217.27 | $482.09 | $1,221.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $83.43 / $3,472.00 / $9,239.00
| Facility | | $83.43 | $3,472.00 | $9,239.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,156.59 / $1,156.59 / $1,360.70
| Professional | | $1,156.59 | $1,156.59 | $1,360.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $801.62 / $1,058.14 / $2,581.21
| Professional | | $801.62 | $1,058.14 | $2,581.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,394.82 / $3,807.70 / $3,807.70
| Facility | | $1,394.82 | $3,807.70 | $3,807.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.90 / $460.50 / $695.70
| Professional | | $144.90 | $460.50 | $695.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.90 / $480.97 / $1,111.05
| Professional | | $144.90 | $480.97 | $1,111.05 |