- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $588.84 / $1,905.46 / $2,630.27
| Facility | | $588.84 | $1,905.46 | $2,630.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $549.54 / $630.96 / $812.83
| Professional | | $549.54 | $630.96 | $812.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,981.07 / $3,981.07 / $3,981.07
| Facility | | $3,981.07 | $3,981.07 | $3,981.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.81 / $501.19 / $1,258.93
| Professional | | $354.81 | $501.19 | $1,258.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $562.34 / $660.69 / $1,348.96
| Facility | | $562.34 | $660.69 | $1,348.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $954.99 / $1,023.29 / $1,288.25
| Professional | | $954.99 | $1,023.29 | $1,288.25 |
- 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
- $1,202.26 / $1,202.26 / $1,412.54
| Professional | | $1,202.26 | $1,202.26 | $1,412.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $831.76 / $831.76 / $1,862.09
| Professional | | $831.76 | $831.76 | $1,862.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,981.07 / $3,981.07 / $3,981.07
| Facility | | $3,981.07 | $3,981.07 | $3,981.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.81 / $501.19 / $1,258.93
| Professional | | $354.81 | $501.19 | $1,258.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $501.19 / $831.76 / $1,000.00
| Facility | | $501.19 | $831.76 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $380.19 / $645.65 / $1,905.46
| Professional | | $380.19 | $645.65 | $1,905.46 |