- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $478.63 / $478.63 / $6,760.83
| Facility | | $478.63 | $478.63 | $6,760.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $478.63 / $616.60 / $977.24
| Professional | | $478.63 | $616.60 | $977.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,918.31 / $12,302.69 / $36,307.81
| Facility | | $6,918.31 | $12,302.69 | $36,307.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $812.83 / $1,202.26 / $1,949.84
| Professional | | $812.83 | $1,202.26 | $1,949.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,380.38 / $1,949.84 / $4,570.88
| Facility | | $1,380.38 | $1,949.84 | $4,570.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,071.52 / $1,659.59 / $2,454.71
| Professional | | $1,071.52 | $1,659.59 | $2,454.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,479.11 / $1,862.09 / $3,630.78
| Facility | | $1,479.11 | $1,862.09 | $3,630.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,000.00 / $1,380.38 / $2,089.30
| Professional | | $1,000.00 | $1,380.38 | $2,089.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $676.08 / $1,096.48 / $9,332.54
| Facility | | $676.08 | $1,096.48 | $9,332.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $645.65 / $1,096.48 / $2,137.96
| Professional | | $645.65 | $1,096.48 | $2,137.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,311.31 / $6,456.54 / $13,489.63
| Facility | | $3,311.31 | $6,456.54 | $13,489.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $645.65 / $1,096.48 / $2,041.74
| Professional | | $645.65 | $1,096.48 | $2,041.74 |