- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $467.74 / $1,479.11 / $2,089.30
| Facility | | $467.74 | $1,479.11 | $2,089.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $436.52 / $501.19 / $645.65
| Professional | | $436.52 | $501.19 | $645.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,162.28 / $3,162.28 / $3,162.28
| Facility | | $3,162.28 | $3,162.28 | $3,162.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.42 / $398.11 / $1,000.00
| Professional | | $275.42 | $398.11 | $1,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $446.68 / $501.19 / $1,071.52
| Facility | | $446.68 | $501.19 | $1,071.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $660.69 / $758.58 / $954.99
| Professional | | $660.69 | $758.58 | $954.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $83.18 / $4,897.79 / $9,772.37
| Facility | | $83.18 | $4,897.79 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $954.99 / $954.99 / $1,122.02
| Professional | | $954.99 | $954.99 | $1,122.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $660.69 / $660.69 / $1,258.93
| Professional | | $660.69 | $660.69 | $1,258.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,162.28 / $3,162.28 / $3,162.28
| Facility | | $3,162.28 | $3,162.28 | $3,162.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.42 / $398.11 / $1,000.00
| Professional | | $275.42 | $398.11 | $1,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.11 / $660.69 / $794.33
| Facility | | $398.11 | $660.69 | $794.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $295.12 / $398.11 / $1,000.00
| Professional | | $295.12 | $398.11 | $1,000.00 |