- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $724.44 / $1,621.81 / $5,495.41
| Facility | | $724.44 | $1,621.81 | $5,495.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $467.74 / $645.65 / $1,096.48
| Professional | | $467.74 | $645.65 | $1,096.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $123.03 / $831.76 / $4,168.69
| Facility | | $123.03 | $831.76 | $4,168.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $831.76 / $1,000.00 / $1,096.48
| Professional | | $831.76 | $1,000.00 | $1,096.48 |
- 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
- $549.54 / $707.95 / $912.01
| Professional | | $549.54 | $707.95 | $912.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $512.86 / $812.83 / $1,288.25
| Facility | | $512.86 | $812.83 | $1,288.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $812.83 / $1,000.00 / $1,230.27
| Professional | | $812.83 | $1,000.00 | $1,230.27 |
- 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
- $691.83 / $1,000.00 / $1,148.15
| Professional | | $691.83 | $1,000.00 | $1,148.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $467.74 / $630.96 / $1,949.84
| Professional | | $467.74 | $630.96 | $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
- $512.86 / $741.31 / $1,071.52
| Professional | | $512.86 | $741.31 | $1,071.52 |