- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $501.19 / $1,318.26 / $1,905.46
| Facility | | $501.19 | $1,318.26 | $1,905.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $389.05 / $524.81 / $1,445.44
| Professional | | $389.05 | $524.81 | $1,445.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $537.03 / $831.76 / $2,041.74
| Facility | | $537.03 | $831.76 | $2,041.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.81 / $588.84 / $2,187.76
| Professional | | $354.81 | $588.84 | $2,187.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,148.15 / $1,445.44 / $2,290.87
| Facility | | $1,148.15 | $1,445.44 | $2,290.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $575.44 / $676.08 / $676.08
| Professional | | $575.44 | $676.08 | $676.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $457.09 / $562.34 / $1,230.27
| Facility | | $457.09 | $562.34 | $1,230.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.74 / $707.95 / $1,513.56
| Professional | | $346.74 | $707.95 | $1,513.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $83.18 / $3,630.78 / $9,772.37
| Facility | | $83.18 | $3,630.78 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $851.14 / $851.14 / $1,000.00
| Professional | | $851.14 | $851.14 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $588.84 / $588.84 / $1,230.27
| Professional | | $588.84 | $588.84 | $1,230.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $537.03 / $831.76 / $2,041.74
| Facility | | $537.03 | $831.76 | $2,041.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.81 / $588.84 / $2,187.76
| Professional | | $354.81 | $588.84 | $2,187.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $436.52 / $588.84 / $870.96
| Facility | | $436.52 | $588.84 | $870.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.81 / $588.84 / $1,174.90
| Professional | | $354.81 | $588.84 | $1,174.90 |