- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $576.29 / $3,908.01 / $13,841.56
| Facility | | $576.29 | $3,908.01 | $13,841.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $527.52 / $576.29 / $2,773.72
| Professional | | $527.52 | $576.29 | $2,773.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,350.61 / $4,406.97 / $8,524.51
| Facility | | $3,350.61 | $4,406.97 | $8,524.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $551.51 / $913.03 / $1,253.45
| Professional | | $551.51 | $913.03 | $1,253.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,257.44 / $1,257.44 / $1,257.44
| Facility | | $1,257.44 | $1,257.44 | $1,257.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $914.00 / $1,361.33 / $1,819.20
| Professional | | $914.00 | $1,361.33 | $1,819.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $528.04 / $976.87 / $1,592.85
| Facility | | $528.04 | $976.87 | $1,592.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $745.99 / $1,249.83 / $4,318.72
| Professional | | $745.99 | $1,249.83 | $4,318.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,110.00 / $1,395.36 / $1,775.94
| Facility | | $1,110.00 | $1,395.36 | $1,775.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,033.33 / $1,297.67 / $1,775.94
| Professional | | $1,033.33 | $1,297.67 | $1,775.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $607.24 / $1,058.78 / $1,281.09
| Professional | | $607.24 | $1,058.78 | $1,281.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,056.00 / $1,527.00 / $4,317.00
| Facility | | $1,056.00 | $1,527.00 | $4,317.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $745.99 / $1,337.28 / $1,606.75
| Professional | | $745.99 | $1,337.28 | $1,606.75 |