- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $323.59 / $870.96 / $1,445.44
| Facility | | $323.59 | $870.96 | $1,445.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $309.03 / $363.08 / $446.68
| Professional | | $309.03 | $363.08 | $446.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $489.78 / $1,202.26 / $2,238.72
| Facility | | $489.78 | $1,202.26 | $2,238.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.84 / $467.74 / $1,380.38
| Professional | | $281.84 | $467.74 | $1,380.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $467.74 / $588.84 / $831.76
| Facility | | $467.74 | $588.84 | $831.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $398.11 / $398.11 / $398.11
| Professional | | $398.11 | $398.11 | $398.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $331.13 / $363.08 / $741.31
| Facility | | $331.13 | $363.08 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.42 / $562.34 / $676.08
| Professional | | $275.42 | $562.34 | $676.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $83.18 / $4,897.79 / $9,772.37
| Facility | | $83.18 | $4,897.79 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $676.08 / $676.08 / $794.33
| Professional | | $676.08 | $676.08 | $794.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $467.74 / $467.74 / $1,000.00
| Professional | | $467.74 | $467.74 | $1,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $489.78 / $1,202.26 / $2,238.72
| Facility | | $489.78 | $1,202.26 | $2,238.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.84 / $467.74 / $1,380.38
| Professional | | $281.84 | $467.74 | $1,380.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $281.84 / $467.74 / $562.34
| Facility | | $281.84 | $467.74 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.84 / $467.74 / $954.99
| Professional | | $281.84 | $467.74 | $954.99 |