- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $848.48 / $2,663.12 / $4,903.71
| Facility | | $848.48 | $2,663.12 | $4,903.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $657.78 / $848.48 / $1,346.83
| Professional | | $657.78 | $848.48 | $1,346.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,484.50 / $4,751.20 / $13,773.00
| Facility | | $1,484.50 | $4,751.20 | $13,773.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $729.78 / $1,490.79 / $5,874.32
| Professional | | $729.78 | $1,490.79 | $5,874.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $794.61 / $1,021.07 / $1,822.84
| Facility | | $794.61 | $1,021.07 | $1,822.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,303.00 / $1,581.55 / $1,972.22
| Professional | | $1,303.00 | $1,581.55 | $1,972.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $808.92 / $1,326.62 / $2,308.83
| Professional | | $808.92 | $1,326.62 | $2,308.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $672.56 / $1,448.88 / $6,679.00
| Facility | | $672.56 | $1,448.88 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $929.28 / $1,125.66 / $1,547.60
| Professional | | $929.28 | $1,125.66 | $1,547.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $845.33 / $1,743.38 / $2,317.21
| Professional | | $845.33 | $1,743.38 | $2,317.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,324.00 / $5,063.00 / $16,394.00
| Facility | | $2,324.00 | $5,063.00 | $16,394.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $954.05 / $1,758.64 / $5,874.32
| Professional | | $954.05 | $1,758.64 | $5,874.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,324.00 / $5,097.00 / $10,764.00
| Facility | | $2,324.00 | $5,097.00 | $10,764.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $925.38 / $1,471.04 / $2,878.94
| Professional | | $925.38 | $1,471.04 | $2,878.94 |