- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $691.83 / $2,818.38 / $5,128.61
| Facility | | $691.83 | $2,818.38 | $5,128.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $602.56 / $891.25 / $2,089.30
| Professional | | $602.56 | $891.25 | $2,089.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,348.96 / $2,754.23 / $28,840.32
| Facility | | $1,348.96 | $2,754.23 | $28,840.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $630.96 / $1,148.15 / $3,162.28
| Professional | | $630.96 | $1,148.15 | $3,162.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $954.99 / $954.99 / $2,187.76
| Facility | | $954.99 | $954.99 | $2,187.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $691.83 / $1,288.25 / $2,570.40
| Professional | | $691.83 | $1,288.25 | $2,570.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $501.19 / $1,778.28 / $7,079.46
| Facility | | $501.19 | $1,778.28 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,202.26 / $1,445.44 / $1,819.70
| Professional | | $1,202.26 | $1,445.44 | $1,819.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,698.24 / $3,630.78 / $8,511.38
| Facility | | $1,698.24 | $3,630.78 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $933.25 / $1,513.56 / $2,630.27
| Professional | | $933.25 | $1,513.56 | $2,630.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,698.24 / $2,754.23 / $28,840.32
| Facility | | $1,698.24 | $2,754.23 | $28,840.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $630.96 / $1,148.15 / $3,162.28
| Professional | | $630.96 | $1,148.15 | $3,162.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,584.89 / $3,630.78 / $8,511.38
| Facility | | $1,584.89 | $3,630.78 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $630.96 / $1,202.26 / $2,630.27
| Professional | | $630.96 | $1,202.26 | $2,630.27 |