- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $660.69 / $3,090.30 / $8,709.64
| Facility | | $660.69 | $3,090.30 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $331.13 / $562.34 / $1,230.27
| Professional | | $331.13 | $562.34 | $1,230.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.93 / $223.87 / $446.68
| Professional | | $208.93 | $223.87 | $446.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,344.23 / $2,570.40 / $57,543.99
| Facility | | $2,344.23 | $2,570.40 | $57,543.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $398.11 / $630.96 / $1,000.00
| Professional | | $398.11 | $630.96 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $831.76 / $1,071.52 / $1,174.90
| Professional | | $831.76 | $1,071.52 | $1,174.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $512.86 / $870.96 / $1,445.44
| Professional | | $512.86 | $870.96 | $1,445.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,380.38 / $6,918.31 / $7,585.78
| Facility | | $1,380.38 | $6,918.31 | $7,585.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $660.69 / $2,454.71 / $8,511.38
| Facility | | $660.69 | $2,454.71 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $363.08 / $645.65 / $1,445.44
| Professional | | $363.08 | $645.65 | $1,445.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $602.56 / $602.56 / $602.56
| Professional | | $602.56 | $602.56 | $602.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $407.38 / $630.96 / $1,023.29
| Facility | | $407.38 | $630.96 | $1,023.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $407.38 / $630.96 / $1,023.29
| Professional | | $407.38 | $630.96 | $1,023.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $467.74 / $2,238.72 / $8,912.51
| Facility | | $467.74 | $2,238.72 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $380.19 / $602.56 / $1,023.29
| Professional | | $380.19 | $602.56 | $1,023.29 |