- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $186.21 / $1,230.27 / $5,495.41
| Facility | | $186.21 | $1,230.27 | $5,495.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $426.58 / $588.84 / $1,023.29
| Professional | | $426.58 | $588.84 | $1,023.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $138.04 / $1,905.46 / $4,168.69
| Facility | | $138.04 | $1,905.46 | $4,168.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $776.25 / $912.01 / $1,023.29
| Professional | | $776.25 | $912.01 | $1,023.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $1,000.00 / $1,000.00
| Facility | | $1,000.00 | $1,000.00 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $501.19 / $645.65 / $851.14
| Professional | | $501.19 | $645.65 | $851.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $467.74 / $776.25 / $1,230.27
| Facility | | $467.74 | $776.25 | $1,230.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $776.25 / $954.99 / $1,174.90
| Professional | | $776.25 | $954.99 | $1,174.90 |
- 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
- $2,691.53 / $3,630.78 / $5,011.87
| Facility | | $2,691.53 | $3,630.78 | $5,011.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $645.65 / $933.25 / $1,071.52
| Professional | | $645.65 | $933.25 | $1,071.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $436.52 / $602.56 / $1,949.84
| Professional | | $436.52 | $602.56 | $1,949.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $151.36 / $1,819.70 / $9,332.54
| Facility | | $151.36 | $1,819.70 | $9,332.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $478.63 / $691.83 / $1,000.00
| Professional | | $478.63 | $691.83 | $1,000.00 |