- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $709.55 / $2,497.94 / $3,444.38
| Facility | | $709.55 | $2,497.94 | $3,444.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $709.55 / $725.98 / $999.44
| Professional | | $709.55 | $725.98 | $999.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,079.42 / $2,079.42 / $5,379.71
| Facility | | $2,079.42 | $2,079.42 | $5,379.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $953.15 / $1,384.73 / $5,190.18
| Professional | | $953.15 | $1,384.73 | $5,190.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $159.78 / $252.80 / $428.30
| Facility | | $159.78 | $252.80 | $428.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $121.74 / $772.18 / $1,338.78
| Facility | | $121.74 | $772.18 | $1,338.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,100.63 / $1,692.61 / $2,636.60
| Professional | | $1,100.63 | $1,692.61 | $2,636.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,009.43 / $1,708.13 / $8,090.00
| Facility | | $1,009.43 | $1,708.13 | $8,090.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,158.32 / $1,463.67 / $2,307.56
| Professional | | $1,158.32 | $1,463.67 | $2,307.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,028.47 / $2,199.34 / $3,045.47
| Professional | | $1,028.47 | $2,199.34 | $3,045.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,079.42 / $2,079.42 / $5,379.71
| Facility | | $2,079.42 | $2,079.42 | $5,379.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $953.15 / $1,384.73 / $5,190.18
| Professional | | $953.15 | $1,384.73 | $5,190.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $714.06 / $1,347.49 / $2,005.32
| Facility | | $714.06 | $1,347.49 | $2,005.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $952.91 / $1,384.73 / $2,259.41
| Professional | | $952.91 | $1,384.73 | $2,259.41 |