- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $597.91 / $1,637.85 / $2,671.51
| Facility | | $597.91 | $1,637.85 | $2,671.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $448.43 / $448.43 / $719.07
| Professional | | $448.43 | $448.43 | $719.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $441.77 / $1,040.35 / $3,191.10
| Facility | | $441.77 | $1,040.35 | $3,191.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $95.22 / $583.22 / $2,245.17
| Professional | | $95.22 | $583.22 | $2,245.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $950.33 / $1,358.97 / $2,375.83
| Facility | | $950.33 | $1,358.97 | $2,375.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $562.04 / $562.04 / $591.92
| Professional | | $562.04 | $562.04 | $591.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $392.98 / $491.39 / $1,165.69
| Facility | | $392.98 | $491.39 | $1,165.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $349.78 / $597.91 / $2,668.02
| Professional | | $349.78 | $597.91 | $2,668.02 |
- 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
- $862.55 / $862.55 / $1,014.77
| Professional | | $862.55 | $862.55 | $1,014.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $597.91 / $597.91 / $1,925.27
| Professional | | $597.91 | $597.91 | $1,925.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,040.35 / $3,191.10 / $3,191.10
| Facility | | $1,040.35 | $3,191.10 | $3,191.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $75.55 / $358.75 / $2,989.55
| Professional | | $75.55 | $358.75 | $2,989.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $75.55 / $358.75 / $1,067.90
| Professional | | $75.55 | $358.75 | $1,067.90 |