- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $977.37 / $2,171.75 / $2,345.37
| Facility | | $977.37 | $2,171.75 | $2,345.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $222.93 / $222.93 / $1,185.15
| Professional | | $222.93 | $222.93 | $1,185.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $828.23 / $1,339.07 / $2,655.82
| Facility | | $828.23 | $1,339.07 | $2,655.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $461.75 / $769.58 / $3,051.87
| Professional | | $461.75 | $769.58 | $3,051.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,223.00 / $1,748.89 / $3,057.50
| Facility | | $1,223.00 | $1,748.89 | $3,057.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $723.41 / $723.41 / $761.88
| Professional | | $723.41 | $723.41 | $761.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $410.12 / $734.19 / $1,750.81
| Facility | | $410.12 | $734.19 | $1,750.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $408.35 / $738.80 / $2,006.38
| Professional | | $408.35 | $738.80 | $2,006.38 |
- 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
- $1,110.39 / $1,110.39 / $1,306.33
| Professional | | $1,110.39 | $1,110.39 | $1,306.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $769.58 / $769.58 / $2,383.31
| Professional | | $769.58 | $769.58 | $2,383.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,339.07 / $3,655.51 / $3,655.51
| Facility | | $1,339.07 | $3,655.51 | $3,655.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $461.75 / $461.75 / $3,847.90
| Professional | | $461.75 | $461.75 | $3,847.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $461.75 / $461.75 / $1,346.77
| Professional | | $461.75 | $461.75 | $1,346.77 |