- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $200.98 / $1,113.86 / $1,956.10
| Facility | | $200.98 | $1,113.86 | $1,956.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $190.29 / $426.83 / $850.00
| Professional | | $190.29 | $426.83 | $850.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $474.24 / $732.46 / $1,965.34
| Facility | | $474.24 | $732.46 | $1,965.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $269.58 / $594.33 / $2,545.34
| Professional | | $269.58 | $594.33 | $2,545.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,020.21 / $1,458.90 / $2,550.53
| Facility | | $1,020.21 | $1,458.90 | $2,550.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $269.88 / $269.88 / $269.88
| Professional | | $269.88 | $269.88 | $269.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $235.16 / $500.64 / $1,460.20
| Facility | | $235.16 | $500.64 | $1,460.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $340.41 / $616.15 / $1,673.49
| Professional | | $340.41 | $616.15 | $1,673.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $83.43 / $4,618.00 / $9,239.00
| Facility | | $83.43 | $4,618.00 | $9,239.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $926.02 / $926.02 / $1,089.44
| Professional | | $926.02 | $926.02 | $1,089.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $641.85 / $641.85 / $1,987.75
| Professional | | $641.85 | $641.85 | $1,987.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,116.82 / $3,048.79 / $3,048.79
| Facility | | $1,116.82 | $3,048.79 | $3,048.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $172.70 / $385.11 / $3,209.25
| Professional | | $172.70 | $385.11 | $3,209.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $172.70 / $385.11 / $1,223.41
| Professional | | $172.70 | $385.11 | $1,223.41 |