- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $478.63 / $1,949.84 / $1,949.84
| Facility | | $478.63 | $1,949.84 | $1,949.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $724.44 / $1,000.00 / $3,090.30
| Professional | | $724.44 | $1,000.00 | $3,090.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,000.00 / $1,000.00 / $4,168.69
| Professional | | $1,000.00 | $1,000.00 | $4,168.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,818.38 / $3,311.31 / $5,248.07
| Facility | | $2,818.38 | $3,311.31 | $5,248.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,288.25 / $1,621.81 / $3,019.95
| Professional | | $1,288.25 | $1,621.81 | $3,019.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $794.33 / $1,230.27 / $1,318.26
| Facility | | $794.33 | $1,230.27 | $1,318.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $691.83 / $1,230.27 / $6,918.31
| Facility | | $691.83 | $1,230.27 | $6,918.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $537.03 / $630.96 / $1,778.28
| Professional | | $537.03 | $630.96 | $1,778.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $741.31 / $3,090.30 / $4,466.84
| Professional | | $741.31 | $3,090.30 | $4,466.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,089.30 / $2,089.30 / $6,918.31
| Facility | | $2,089.30 | $2,089.30 | $6,918.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $512.86 / $524.81 / $707.95
| Professional | | $512.86 | $524.81 | $707.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,128.61 / $5,128.61 / $5,128.61
| Professional | | $5,128.61 | $5,128.61 | $5,128.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $114.82 / $457.09 / $794.33
| Facility | | $114.82 | $457.09 | $794.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $457.09 / $776.25 / $1,995.26
| Professional | | $457.09 | $776.25 | $1,995.26 |