- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $884.47 / $2,009.01 / $3,601.06
| Facility | | $884.47 | $2,009.01 | $3,601.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $669.67 / $830.77 / $1,074.00
| Professional | | $669.67 | $830.77 | $1,074.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.49 / $7.49 / $758.11
| Professional | | $7.49 | $7.49 | $758.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,516.24 / $2,669.19 / $4,548.43
| Facility | | $1,516.24 | $2,669.19 | $4,548.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,538.80 / $6,090.21 / $6,090.21
| Professional | | $1,538.80 | $6,090.21 | $6,090.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $294.00 / $1,516.24 / $2,842.94
| Facility | | $294.00 | $1,516.24 | $2,842.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,326.71 / $1,655.22 / $2,741.86
| Professional | | $1,326.71 | $1,655.22 | $2,741.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,074.00 / $1,247.91 / $2,291.15
| Professional | | $1,074.00 | $1,247.91 | $2,291.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $597.00 / $2,669.19 / $4,548.43
| Facility | | $597.00 | $2,669.19 | $4,548.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $821.29 / $1,364.61 / $2,906.12
| Professional | | $821.29 | $1,364.61 | $2,906.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $530.67 / $758.12 / $1,983.55
| Professional | | $530.67 | $758.12 | $1,983.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,290.33 / $1,453.03 / $1,453.03
| Facility | | $1,290.33 | $1,453.03 | $1,453.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,074.00 / $1,290.33 / $1,518.66
| Professional | | $1,074.00 | $1,290.33 | $1,518.66 |