- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $399.77 / $4,684.68 / $8,728.00
| Facility | | $399.77 | $4,684.68 | $8,728.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $183.01 / $519.05 / $1,493.76
| Professional | | $183.01 | $519.05 | $1,493.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,457.38 / $1,457.38 / $2,059.63
| Facility | | $1,457.38 | $1,457.38 | $2,059.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $280.81 / $545.33 / $1,495.48
| Professional | | $280.81 | $545.33 | $1,495.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $342.26 / $502.85 / $1,340.42
| Professional | | $342.26 | $502.85 | $1,340.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $273.45 / $563.79 / $1,521.50
| Facility | | $273.45 | $563.79 | $1,521.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $307.37 / $784.08 / $1,440.00
| Professional | | $307.37 | $784.08 | $1,440.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $275.93 / $794.44 / $1,570.26
| Facility | | $275.93 | $794.44 | $1,570.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.37 / $712.87 / $1,489.09
| Professional | | $346.37 | $712.87 | $1,489.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,830.49 / $3,730.83 / $4,417.60
| Facility | | $2,830.49 | $3,730.83 | $4,417.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $347.65 / $981.04 / $1,525.77
| Professional | | $347.65 | $981.04 | $1,525.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,472.00 / $4,880.00 / $7,233.00
| Facility | | $1,472.00 | $4,880.00 | $7,233.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $827.33 / $1,149.88 / $1,746.14
| Professional | | $827.33 | $1,149.88 | $1,746.14 |