- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $421.47 / $2,308.12 / $3,973.92
| Facility | | $421.47 | $2,308.12 | $3,973.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $395.88 / $421.47 / $751.06
| Professional | | $395.88 | $421.47 | $751.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $400.38 / $1,280.35 / $6,193.76
| Facility | | $400.38 | $1,280.35 | $6,193.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $263.36 / $441.75 / $1,648.20
| Professional | | $263.36 | $441.75 | $1,648.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $861.54 / $1,232.00 / $2,153.85
| Facility | | $861.54 | $1,232.00 | $2,153.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,225.71 / $1,225.71 / $1,225.71
| Professional | | $1,225.71 | $1,225.71 | $1,225.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $306.70 / $432.55 / $998.55
| Facility | | $306.70 | $432.55 | $998.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $263.30 / $462.95 / $2,175.92
| Professional | | $263.30 | $462.95 | $2,175.92 |
- 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
- $1,881.45 / $1,881.45 / $2,213.46
| Professional | | $1,881.45 | $1,881.45 | $2,213.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,303.95 / $1,303.95 / $1,807.27
| Professional | | $1,303.95 | $1,303.95 | $1,807.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,268.87 / $6,193.76 / $6,193.76
| Facility | | $2,268.87 | $6,193.76 | $6,193.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $263.36 / $361.26 / $6,493.67
| Professional | | $263.36 | $361.26 | $6,493.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $210.74 / $361.26 / $907.18
| Professional | | $210.74 | $361.26 | $907.18 |