- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $500.00 / $1,744.23 / $2,311.17
| Facility | | $500.00 | $1,744.23 | $2,311.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $500.00 / $504.31 / $1,167.86
| Professional | | $500.00 | $504.31 | $1,167.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $886.33 / $2,109.33 / $2,617.10
| Facility | | $886.33 | $2,109.33 | $2,617.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $455.02 / $758.36 / $3,007.38
| Professional | | $455.02 | $758.36 | $3,007.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $468.26 / $1,622.25 / $3,013.10
| Facility | | $468.26 | $1,622.25 | $3,013.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $317.77 / $317.77 / $317.77
| Professional | | $317.77 | $317.77 | $317.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $331.16 / $592.83 / $1,725.26
| Facility | | $331.16 | $592.83 | $1,725.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $449.87 / $728.06 / $1,976.61
| Professional | | $449.87 | $728.06 | $1,976.61 |
- 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
- $1,094.05 / $1,094.05 / $1,287.11
| Professional | | $1,094.05 | $1,094.05 | $1,287.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $758.36 / $758.36 / $2,348.57
| Professional | | $758.36 | $758.36 | $2,348.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,319.55 / $3,602.21 / $3,602.21
| Facility | | $1,319.55 | $3,602.21 | $3,602.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $455.02 / $455.02 / $3,791.80
| Professional | | $455.02 | $455.02 | $3,791.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $455.02 / $455.02 / $1,445.49
| Professional | | $455.02 | $455.02 | $1,445.49 |