- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $831.76 / $5,754.40 / $8,511.38
| Facility | | $831.76 | $5,754.40 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $630.96 / $758.58 / $1,905.46
| Professional | | $630.96 | $758.58 | $1,905.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20,417.38 / $21,379.62 / $57,543.99
| Facility | | $20,417.38 | $21,379.62 | $57,543.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $562.34 / $954.99 / $1,230.27
| Professional | | $562.34 | $954.99 | $1,230.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $645.65 / $831.76 / $1,258.93
| Professional | | $645.65 | $831.76 | $1,258.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,000.00 / $1,000.00 / $1,122.02
| Professional | | $1,000.00 | $1,000.00 | $1,122.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $691.83 / $912.01 / $1,445.44
| Professional | | $691.83 | $912.01 | $1,445.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $831.76 / $4,265.80 / $8,317.64
| Facility | | $831.76 | $4,265.80 | $8,317.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $660.69 / $851.14 / $2,089.30
| Professional | | $660.69 | $851.14 | $2,089.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $645.65 / $676.08 / $1,621.81
| Professional | | $645.65 | $676.08 | $1,621.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.44 / $575.44 / $630.96
| Facility | | $575.44 | $575.44 | $630.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $575.44 / $630.96 / $660.69
| Professional | | $575.44 | $630.96 | $660.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $660.69 / $2,570.40 / $6,760.83
| Facility | | $660.69 | $2,570.40 | $6,760.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $602.56 / $794.33 / $1,318.26
| Professional | | $602.56 | $794.33 | $1,318.26 |