- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $758.26 / $758.26 / $4,660.50
| Facility | | $758.26 | $758.26 | $4,660.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $758.26 / $766.22 / $4,897.38
| Professional | | $758.26 | $766.22 | $4,897.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $241.21 / $3,243.99 / $6,928.83
| Facility | | $241.21 | $3,243.99 | $6,928.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $539.12 / $1,203.01 / $3,005.36
| Professional | | $539.12 | $1,203.01 | $3,005.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $165.51 / $250.42 / $413.78
| Facility | | $165.51 | $250.42 | $413.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $73.05 / $1,346.03 / $2,635.12
| Facility | | $73.05 | $1,346.03 | $2,635.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $526.25 / $1,116.89 / $1,627.74
| Professional | | $526.25 | $1,116.89 | $1,627.74 |
- 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
- $1,564.53 / $1,564.53 / $1,840.62
| Professional | | $1,564.53 | $1,564.53 | $1,840.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $292.29 / $1,272.00 / $2,544.00
| Professional | | $292.29 | $1,272.00 | $2,544.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,590.23 / $1,590.23 / $1,590.23
| Facility | | $1,590.23 | $1,590.23 | $1,590.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,153.98 / $6,928.83 / $6,928.83
| Facility | | $2,153.98 | $6,928.83 | $6,928.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $355.13 / $706.38 / $1,779.04
| Professional | | $355.13 | $706.38 | $1,779.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $355.13 / $833.75 / $2,682.18
| Professional | | $355.13 | $833.75 | $2,682.18 |