- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $932.06 / $2,124.38 / $3,741.05
| Facility | | $932.06 | $2,124.38 | $3,741.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $708.13 / $878.48 / $1,135.68
| Professional | | $708.13 | $878.48 | $1,135.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $423.14 / $423.14 / $1,260.95
| Professional | | $423.14 | $423.14 | $1,260.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $868.46 / $1,875.87 / $4,666.97
| Facility | | $868.46 | $1,875.87 | $4,666.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,627.23 / $6,439.95 / $6,439.95
| Professional | | $1,627.23 | $6,439.95 | $6,439.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $294.00 / $1,603.31 / $3,006.20
| Facility | | $294.00 | $1,603.31 | $3,006.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,402.89 / $1,763.64 / $2,899.32
| Professional | | $1,402.89 | $1,763.64 | $2,899.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,135.68 / $1,336.09 / $2,422.71
| Professional | | $1,135.68 | $1,336.09 | $2,422.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $597.00 / $1,875.87 / $4,810.43
| Facility | | $597.00 | $1,875.87 | $4,810.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $868.46 / $1,456.34 / $3,073.01
| Professional | | $868.46 | $1,456.34 | $3,073.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,202.48 / $1,202.48 / $1,336.09
| Facility | | $1,202.48 | $1,202.48 | $1,336.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $561.16 / $801.65 / $2,140.42
| Professional | | $561.16 | $801.65 | $2,140.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,336.09 / $1,536.47 / $1,536.47
| Facility | | $1,336.09 | $1,536.47 | $1,536.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,135.68 / $1,336.09 / $1,605.87
| Professional | | $1,135.68 | $1,336.09 | $1,605.87 |