- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $518.11 / $3,908.01 / $13,841.56
| Facility | | $518.11 | $3,908.01 | $13,841.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $471.09 / $518.11 / $2,661.91
| Professional | | $471.09 | $518.11 | $2,661.91 |
- 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
- $495.82 / $815.53 / $1,126.89
| Professional | | $495.82 | $815.53 | $1,126.89 |
- 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
- $786.00 / $1,188.13 / $1,627.90
| Professional | | $786.00 | $1,188.13 | $1,627.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $471.09 / $871.52 / $1,372.38
| Facility | | $471.09 | $871.52 | $1,372.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $668.03 / $1,110.75 / $3,840.24
| Professional | | $668.03 | $1,110.75 | $3,840.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $960.00 / $1,270.01 / $1,627.90
| Facility | | $960.00 | $1,270.01 | $1,627.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $921.71 / $1,157.20 / $1,589.29
| Professional | | $921.71 | $1,157.20 | $1,589.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $541.91 / $944.87 / $1,147.81
| Professional | | $541.91 | $944.87 | $1,147.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,031.00 / $1,775.00 / $4,406.00
| Facility | | $1,031.00 | $1,775.00 | $4,406.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $668.03 / $1,110.75 / $1,438.84
| Professional | | $668.03 | $1,110.75 | $1,438.84 |