- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $562.34 / $977.24 / $1,122.02
| Facility | | $562.34 | $977.24 | $1,122.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $426.58 / $549.54 / $977.24
| Professional | | $426.58 | $549.54 | $977.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.44 / $575.44 / $2,041.74
| Facility | | $575.44 | $575.44 | $2,041.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $288.40 / $489.78 / $1,513.56
| Professional | | $288.40 | $489.78 | $1,513.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,096.48 / $1,148.15 / $1,318.26
| Facility | | $1,096.48 | $1,148.15 | $1,318.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $691.83 / $1,096.48 / $3,467.37
| Facility | | $691.83 | $1,096.48 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $316.23 / $588.84 / $831.76
| Professional | | $316.23 | $588.84 | $831.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $524.81 / $1,000.00 / $2,754.23
| Facility | | $524.81 | $1,000.00 | $2,754.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.47 / $363.08 / $707.95
| Professional | | $245.47 | $363.08 | $707.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $316.23 / $575.44 / $707.95
| Facility | | $316.23 | $575.44 | $707.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.47 / $346.74 / $707.95
| Professional | | $245.47 | $346.74 | $707.95 |