- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $446.68 / $3,090.30 / $5,128.61
| Facility | | $446.68 | $3,090.30 | $5,128.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $407.38 / $524.81 / $1,380.38
| Professional | | $407.38 | $524.81 | $1,380.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,230.27 / $3,630.78 / $45,708.82
| Facility | | $1,230.27 | $3,630.78 | $45,708.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $489.78 / $776.25 / $1,862.09
| Professional | | $489.78 | $776.25 | $1,862.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $616.60 / $616.60 / $1,412.54
| Facility | | $616.60 | $616.60 | $1,412.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $489.78 / $794.33 / $1,659.59
| Professional | | $489.78 | $794.33 | $1,659.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $467.74 / $1,000.00 / $7,079.46
| Facility | | $467.74 | $1,000.00 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $616.60 / $794.33 / $1,148.15
| Professional | | $616.60 | $794.33 | $1,148.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,698.24 / $3,630.78 / $8,511.38
| Facility | | $1,698.24 | $3,630.78 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $549.54 / $870.96 / $1,548.82
| Professional | | $549.54 | $870.96 | $1,548.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,230.27 / $3,630.78 / $45,708.82
| Facility | | $1,230.27 | $3,630.78 | $45,708.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $489.78 / $794.33 / $1,949.84
| Professional | | $489.78 | $794.33 | $1,949.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,584.89 / $3,630.78 / $8,511.38
| Facility | | $1,584.89 | $3,630.78 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $478.63 / $758.58 / $1,513.56
| Professional | | $478.63 | $758.58 | $1,513.56 |