- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $381.67 / $1,425.66 / $2,072.00
| Facility | | $381.67 | $1,425.66 | $2,072.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $348.91 / $1,230.89 / $1,451.36
| Professional | | $348.91 | $1,230.89 | $1,451.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $800.56 / $2,894.15 / $2,894.15
| Facility | | $800.56 | $2,894.15 | $2,894.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $402.16 / $563.72 / $1,909.97
| Professional | | $402.16 | $563.72 | $1,909.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,455.78 / $1,693.24 / $2,159.60
| Facility | | $1,455.78 | $1,693.24 | $2,159.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $313.05 / $515.14 / $1,000.65
| Professional | | $313.05 | $515.14 | $1,000.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $177.11 / $8,062.55 / $13,588.20
| Facility | | $177.11 | $8,062.55 | $13,588.20 |
- 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
- $157.18 / $361.88 / $610.66
| Professional | | $157.18 | $361.88 | $610.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $461.21 / $910.43 / $1,170.55
| Professional | | $461.21 | $910.43 | $1,170.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $800.56 / $2,894.15 / $2,894.15
| Facility | | $800.56 | $2,894.15 | $2,894.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $402.16 / $563.72 / $1,909.97
| Professional | | $402.16 | $563.72 | $1,909.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $402.16 / $504.29 / $932.31
| Professional | | $402.16 | $504.29 | $932.31 |