- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $436.52 / $3,630.78 / $9,332.54
| Facility | | $436.52 | $3,630.78 | $9,332.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $323.59 / $426.58 / $776.25
| Professional | | $323.59 | $426.58 | $776.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,090.30 / $3,981.07 / $4,466.84
| Facility | | $3,090.30 | $3,981.07 | $4,466.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $363.08 / $489.78 / $691.83
| Professional | | $363.08 | $489.78 | $691.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $416.87 / $645.65 / $4,466.84
| Professional | | $416.87 | $645.65 | $4,466.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.81 / $478.63 / $831.76
| Professional | | $354.81 | $478.63 | $831.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $323.59 / $512.86 / $1,318.26
| Professional | | $323.59 | $512.86 | $1,318.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $467.74 / $630.96 / $1,000.00
| Professional | | $467.74 | $630.96 | $1,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $380.19 / $512.86 / $794.33
| Facility | | $380.19 | $512.86 | $794.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $323.59 / $489.78 / $8,709.64
| Facility | | $323.59 | $489.78 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.81 / $549.54 / $8,709.64
| Professional | | $354.81 | $549.54 | $8,709.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,890.45 / $7,244.36 / $14,125.38
| Facility | | $3,890.45 | $7,244.36 | $14,125.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $302.00 / $467.74 / $794.33
| Professional | | $302.00 | $467.74 | $794.33 |