- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $407.38 / $407.38 / $10,715.19
| Facility | | $407.38 | $407.38 | $10,715.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $380.19 / $426.58 / $724.44
| Professional | | $380.19 | $426.58 | $724.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $281.84 / $2,818.38 / $8,709.64
| Facility | | $281.84 | $2,818.38 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $537.03 / $812.83 / $1,348.96
| Professional | | $537.03 | $812.83 | $1,348.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $977.24 / $1,380.38 / $3,311.31
| Facility | | $977.24 | $1,380.38 | $3,311.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $776.25 / $1,174.90 / $1,621.81
| Professional | | $776.25 | $1,174.90 | $1,621.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,071.52 / $1,318.26 / $2,570.40
| Facility | | $1,071.52 | $1,318.26 | $2,570.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $741.31 / $1,000.00 / $1,479.11
| Professional | | $741.31 | $1,000.00 | $1,479.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $562.34 / $812.83 / $2,398.83
| Facility | | $562.34 | $812.83 | $2,398.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $489.78 / $794.33 / $1,445.44
| Professional | | $489.78 | $794.33 | $1,445.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,096.48 / $1,862.09 / $3,715.35
| Facility | | $1,096.48 | $1,862.09 | $3,715.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $489.78 / $812.83 / $1,412.54
| Professional | | $489.78 | $812.83 | $1,412.54 |