- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $981.66 / $2,602.90 / $7,302.99
| Facility | | $981.66 | $2,602.90 | $7,302.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $832.93 / $1,100.65 / $1,784.84
| Professional | | $832.93 | $1,100.65 | $1,784.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.00 / $5.50 / $818.05
| Professional | | $5.00 | $5.50 | $818.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,487.37 / $1,487.37 / $1,487.37
| Facility | | $1,487.37 | $1,487.37 | $1,487.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $45.71 / $2,227.92 / $6,333.36
| Facility | | $45.71 | $2,227.92 | $6,333.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $758.50 / $1,198.16 / $2,265.83
| Professional | | $758.50 | $1,198.16 | $2,265.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,379.79 / $7,065.01 / $7,065.01
| Facility | | $2,379.79 | $7,065.01 | $7,065.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $832.93 / $1,487.37 / $1,636.11
| Facility | | $832.93 | $1,487.37 | $1,636.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,405.49 / $1,487.37 / $1,487.37
| Professional | | $1,405.49 | $1,487.37 | $1,487.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $743.69 / $1,487.37 / $2,794.02
| Facility | | $743.69 | $1,487.37 | $2,794.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $758.50 / $1,208.72 / $2,157.00
| Professional | | $758.50 | $1,208.72 | $2,157.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $624.70 / $624.70 / $892.42
| Professional | | $624.70 | $624.70 | $892.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $580.07 / $594.95 / $1,487.37
| Professional | | $580.07 | $594.95 | $1,487.37 |