- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $660.69 / $7,943.28 / $7,943.28
| Facility | | $660.69 | $7,943.28 | $7,943.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $426.58 / $549.54 / $2,290.87
| Professional | | $426.58 | $549.54 | $2,290.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,659.59 / $1,659.59 / $1,659.59
| Facility | | $1,659.59 | $1,659.59 | $1,659.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $562.34 / $933.25 / $1,380.38
| Professional | | $562.34 | $933.25 | $1,380.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $741.31 / $954.99 / $1,148.15
| Professional | | $741.31 | $954.99 | $1,148.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $389.05 / $630.96 / $1,548.82
| Facility | | $389.05 | $630.96 | $1,548.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $436.52 / $616.60 / $2,290.87
| Professional | | $436.52 | $616.60 | $2,290.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $288.40 / $331.13 / $354.81
| Facility | | $288.40 | $331.13 | $354.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $389.05 / $616.60 / $1,258.93
| Facility | | $389.05 | $616.60 | $1,258.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $70.79 / $79.43 / $1,230.27
| Professional | | $70.79 | $79.43 | $1,230.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $831.76 / $1,000.00 / $1,288.25
| Professional | | $831.76 | $1,000.00 | $1,288.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,412.54 / $7,585.78 / $31,622.78
| Facility | | $1,412.54 | $7,585.78 | $31,622.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $575.44 / $891.25 / $1,288.25
| Professional | | $575.44 | $891.25 | $1,288.25 |