- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.03 / $1,420.65 / $2,097.07
| Facility | | $575.03 | $1,420.65 | $2,097.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $507.38 / $575.03 / $668.50
| Professional | | $507.38 | $575.03 | $668.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $676.50 / $676.50 / $3,325.00
| Facility | | $676.50 | $676.50 | $3,325.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $282.81 / $282.81 / $451.95
| Professional | | $282.81 | $282.81 | $451.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $744.15 / $1,451.09 / $5,463.79
| Professional | | $744.15 | $1,451.09 | $5,463.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $439.73 / $1,362.64 / $3,290.00
| Facility | | $439.73 | $1,362.64 | $3,290.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $334.81 / $418.11 / $1,204.98
| Professional | | $334.81 | $418.11 | $1,204.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $676.50 / $811.80 / $1,001.22
| Professional | | $676.50 | $811.80 | $1,001.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $608.85 / $1,052.30 / $1,371.63
| Facility | | $608.85 | $1,052.30 | $1,371.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $677.00 / $982.00 / $1,597.39
| Professional | | $677.00 | $982.00 | $1,597.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $564.47 / $813.15 / $9,929.00
| Facility | | $564.47 | $813.15 | $9,929.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $588.55 / $813.15 / $9,929.00
| Professional | | $588.55 | $813.15 | $9,929.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $284.13 / $351.78 / $898.48
| Professional | | $284.13 | $351.78 | $898.48 |