- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $935.26 / $3,073.01 / $4,071.87
| Facility | | $935.26 | $3,073.01 | $4,071.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $878.48 / $935.26 / $1,082.23
| Professional | | $878.48 | $935.26 | $1,082.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,469.70 / $3,408.38 / $4,881.67
| Facility | | $1,469.70 | $3,408.38 | $4,881.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $801.65 / $1,336.09 / $5,298.44
| Professional | | $801.65 | $1,336.09 | $5,298.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $877.14 / $955.31 / $3,039.61
| Facility | | $877.14 | $955.31 | $3,039.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,627.23 / $1,627.23 / $1,949.60
| Professional | | $1,627.23 | $1,627.23 | $1,949.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $83.43 / $4,618.00 / $9,239.00
| Facility | | $83.43 | $4,618.00 | $9,239.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,928.13 / $1,928.13 / $2,268.38
| Professional | | $1,928.13 | $1,928.13 | $2,268.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,336.09 / $1,336.09 / $2,774.79
| Professional | | $1,336.09 | $1,336.09 | $2,774.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,324.80 / $6,346.43 / $6,346.43
| Facility | | $2,324.80 | $6,346.43 | $6,346.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $801.65 / $801.65 / $6,653.73
| Professional | | $801.65 | $801.65 | $6,653.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,202.48 / $1,336.09 / $1,603.31
| Facility | | $1,202.48 | $1,336.09 | $1,603.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $801.65 / $801.65 / $2,761.43
| Professional | | $801.65 | $801.65 | $2,761.43 |