- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $939.60 / $1,868.79 / $3,354.23
| Facility | | $939.60 | $1,868.79 | $3,354.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $614.79 / $904.80 / $1,531.20
| Professional | | $614.79 | $904.80 | $1,531.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $44.57 / $360.00 / $696.00
| Professional | | $44.57 | $360.00 | $696.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,437.53 / $2,450.50 / $4,312.05
| Facility | | $1,437.53 | $2,450.50 | $4,312.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $687.58 / $1,748.19 / $5,958.81
| Professional | | $687.58 | $1,748.19 | $5,958.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $332.00 / $1,197.94 / $2,695.37
| Facility | | $332.00 | $1,197.94 | $2,695.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $838.56 / $1,249.81 / $2,192.23
| Professional | | $838.56 | $1,249.81 | $2,192.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $958.35 / $1,138.04 / $2,068.92
| Professional | | $958.35 | $1,138.04 | $2,068.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13.73 / $1,437.53 / $4,312.05
| Facility | | $13.73 | $1,437.53 | $4,312.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $718.67 / $1,341.69 / $3,120.40
| Professional | | $718.67 | $1,341.69 | $3,120.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $487.20 / $696.00 / $1,798.00
| Professional | | $487.20 | $696.00 | $1,798.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,229.59 / $1,229.59 / $1,229.59
| Facility | | $1,229.59 | $1,229.59 | $1,229.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $986.00 / $1,160.00 / $1,365.32
| Professional | | $986.00 | $1,160.00 | $1,365.32 |