- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $776.25 / $2,951.21 / $3,801.89
| Facility | | $776.25 | $2,951.21 | $3,801.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $741.31 / $954.99 / $1,230.27
| Professional | | $741.31 | $954.99 | $1,230.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,445.44 / $2,691.53 / $6,165.95
| Facility | | $1,445.44 | $2,691.53 | $6,165.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $676.08 / $1,318.26 / $4,897.79
| Professional | | $676.08 | $1,318.26 | $4,897.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,122.02 / $1,412.54 / $1,995.26
| Facility | | $1,122.02 | $1,412.54 | $1,995.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $794.33 / $1,023.29 / $2,089.30
| Facility | | $794.33 | $1,023.29 | $2,089.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,584.89 / $1,584.89 / $1,905.46
| Professional | | $1,584.89 | $1,584.89 | $1,905.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $83.18 / $4,897.79 / $9,772.37
| Facility | | $83.18 | $4,897.79 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,862.09 / $1,862.09 / $2,238.72
| Professional | | $1,862.09 | $1,862.09 | $2,238.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,318.26 / $1,318.26 / $2,754.23
| Professional | | $1,318.26 | $1,318.26 | $2,754.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,445.44 / $2,691.53 / $6,165.95
| Facility | | $1,445.44 | $2,691.53 | $6,165.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $676.08 / $1,318.26 / $4,897.79
| Professional | | $676.08 | $1,318.26 | $4,897.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $776.25 / $1,318.26 / $1,348.96
| Facility | | $776.25 | $1,318.26 | $1,348.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $676.08 / $1,122.02 / $2,290.87
| Professional | | $676.08 | $1,122.02 | $2,290.87 |