- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $632.35 / $5,000.27 / $7,838.38
| Facility | | $632.35 | $5,000.27 | $7,838.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $496.66 / $581.83 / $997.68
| Professional | | $496.66 | $581.83 | $997.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,835.94 / $6,357.37 / $9,865.12
| Facility | | $1,835.94 | $6,357.37 | $9,865.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $470.84 / $704.71 / $913.17
| Professional | | $470.84 | $704.71 | $913.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,300.00 / $1,300.00 / $1,300.00
| Facility | | $1,300.00 | $1,300.00 | $1,300.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $467.56 / $855.87 / $1,126.53
| Professional | | $467.56 | $855.87 | $1,126.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $841.90 / $1,136.56
| Professional | | $32.34 | $841.90 | $1,136.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $535.87 / $715.59 / $1,300.00
| Facility | | $535.87 | $715.59 | $1,300.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $467.56 / $855.87 / $1,114.88
| Professional | | $467.56 | $855.87 | $1,114.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $639.00 / $5,971.00 / $8,422.00
| Facility | | $639.00 | $5,971.00 | $8,422.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $595.12 / $836.43 / $1,201.30
| Professional | | $595.12 | $836.43 | $1,201.30 |