- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $886.25 / $2,013.05 / $3,608.30
| Facility | | $886.25 | $2,013.05 | $3,608.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $671.02 / $832.44 / $1,076.16
| Professional | | $671.02 | $832.44 | $1,076.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,440.00 / $1,440.00 / $5,185.21
| Professional | | $1,440.00 | $1,440.00 | $5,185.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,278.88 / $2,674.59 / $4,557.75
| Facility | | $2,278.88 | $2,674.59 | $4,557.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,542.30 / $6,102.46 / $6,102.46
| Professional | | $1,542.30 | $6,102.46 | $6,102.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $294.00 / $1,519.28 / $2,848.66
| Facility | | $294.00 | $1,519.28 | $2,848.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,329.37 / $1,658.55 / $2,747.37
| Professional | | $1,329.37 | $1,658.55 | $2,747.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,076.16 / $1,250.42 / $2,295.76
| Professional | | $1,076.16 | $1,250.42 | $2,295.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $597.00 / $2,674.59 / $4,557.75
| Facility | | $597.00 | $2,674.59 | $4,557.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $822.95 / $1,367.36 / $2,911.96
| Professional | | $822.95 | $1,367.36 | $2,911.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $531.75 / $759.64 / $1,987.54
| Professional | | $531.75 | $759.64 | $1,987.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,292.93 / $1,455.95 / $1,455.95
| Facility | | $1,292.93 | $1,455.95 | $1,455.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,076.16 / $1,292.93 / $1,521.71
| Professional | | $1,076.16 | $1,292.93 | $1,521.71 |