- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,412.54 / $2,137.96 / $5,495.41
| Facility | | $1,412.54 | $2,137.96 | $5,495.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $630.96 / $977.24 / $1,659.59
| Professional | | $630.96 | $977.24 | $1,659.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $489.78 / $1,659.59 / $4,570.88
| Facility | | $489.78 | $1,659.59 | $4,570.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,148.15 / $1,412.54 / $1,698.24
| Professional | | $1,148.15 | $1,412.54 | $1,698.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $741.31 / $741.31 / $741.31
| Facility | | $741.31 | $741.31 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $741.31 / $1,071.52 / $1,412.54
| Professional | | $741.31 | $1,071.52 | $1,412.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $676.08 / $1,174.90 / $2,089.30
| Facility | | $676.08 | $1,174.90 | $2,089.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,122.02 / $1,479.11 / $1,778.28
| Professional | | $1,122.02 | $1,479.11 | $1,778.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $32.36 / $33.11
| Professional | | $32.36 | $32.36 | $33.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,630.27 / $3,467.37 / $4,786.30
| Facility | | $2,630.27 | $3,467.37 | $4,786.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,000.00 / $1,445.44 / $1,778.28
| Professional | | $1,000.00 | $1,445.44 | $1,778.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $758.58 / $1,230.27 / $2,344.23
| Professional | | $758.58 | $1,230.27 | $2,344.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $676.08 / $3,467.37 / $7,762.47
| Facility | | $676.08 | $3,467.37 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $707.95 / $1,071.52 / $1,584.89
| Professional | | $707.95 | $1,071.52 | $1,584.89 |