- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $719.07 / $2,503.71 / $2,785.51
| Facility | | $719.07 | $2,503.71 | $2,785.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $719.07 / $719.07 / $1,407.56
| Professional | | $719.07 | $719.07 | $1,407.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,068.23 / $2,798.67 / $4,341.50
| Facility | | $1,068.23 | $2,798.67 | $4,341.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $548.40 / $914.00 / $3,432.10
| Professional | | $548.40 | $914.00 | $3,432.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $60.61 / $1,230.24 / $2,285.00
| Facility | | $60.61 | $1,230.24 | $2,285.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $43.29 / $43.29 / $904.86
| Professional | | $43.29 | $43.29 | $904.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $600.73 / $638.66 / $2,079.35
| Facility | | $600.73 | $638.66 | $2,079.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $534.69 / $985.73 / $4,078.43
| Professional | | $534.69 | $985.73 | $4,078.43 |
- 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
- $1,319.02 / $1,319.02 / $1,551.79
| Professional | | $1,319.02 | $1,319.02 | $1,551.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $914.00 / $914.00 / $2,972.10
| Professional | | $914.00 | $914.00 | $2,972.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,590.36 / $4,341.50 / $4,341.50
| Facility | | $1,590.36 | $4,341.50 | $4,341.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $411.30 / $548.40 / $4,570.00
| Professional | | $411.30 | $548.40 | $4,570.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $383.88 / $548.40 / $1,480.83
| Professional | | $383.88 | $548.40 | $1,480.83 |