- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $860.61 / $2,284.52 / $6,402.39
| Facility | | $860.61 | $2,284.52 | $6,402.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $730.21 / $860.61 / $1,108.35
| Professional | | $730.21 | $860.61 | $1,108.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,303.95 / $1,303.95 / $1,303.95
| Professional | | $1,303.95 | $1,303.95 | $1,303.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $80.00 / $80.00 / $80.00
| Facility | | $80.00 | $80.00 | $80.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $744.73 / $2,593.56 / $5,809.88
| Facility | | $744.73 | $2,593.56 | $5,809.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $592.53 / $1,588.27 / $1,902.92
| Professional | | $592.53 | $1,588.27 | $1,902.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,086.32 / $6,193.76 / $6,193.76
| Facility | | $2,086.32 | $6,193.76 | $6,193.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,493.67 / $6,493.67 / $9,779.62
| Professional | | $6,493.67 | $6,493.67 | $9,779.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $782.37 / $1,303.95 / $1,760.33
| Facility | | $782.37 | $1,303.95 | $1,760.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,238.75 / $1,330.03 / $1,955.93
| Professional | | $1,238.75 | $1,330.03 | $1,955.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $847.57 / $1,629.94 / $4,563.82
| Professional | | $847.57 | $1,629.94 | $4,563.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $781.96 / $2,449.48 / $6,912.39
| Facility | | $781.96 | $2,449.48 | $6,912.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $894.38 / $1,564.74 / $2,281.91
| Professional | | $894.38 | $1,564.74 | $2,281.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $469.55 / $469.55 / $715.51
| Professional | | $469.55 | $469.55 | $715.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $335.33 / $436.01 / $1,303.95
| Professional | | $335.33 | $436.01 | $1,303.95 |