- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $821.19 / $2,747.00 / $7,920.26
| Facility | | $821.19 | $2,747.00 | $7,920.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $426.40 / $544.53 / $2,154.40
| Professional | | $426.40 | $544.53 | $2,154.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $560.23 / $843.63 / $1,210.54
| Professional | | $560.23 | $843.63 | $1,210.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $642.52 / $906.14 / $1,031.53
| Professional | | $642.52 | $906.14 | $1,031.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $392.96 / $778.68 / $1,170.74
| Facility | | $392.96 | $778.68 | $1,170.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $661.27 / $941.81 / $1,314.53
| Professional | | $661.27 | $941.81 | $1,314.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.49 / $782.72 / $843.88
| Facility | | $575.49 | $782.72 | $843.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $392.96 / $849.19 / $1,170.74
| Facility | | $392.96 | $849.19 | $1,170.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $719.84 / $978.65 / $1,272.05
| Professional | | $719.84 | $978.65 | $1,272.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,157.83 / $2,157.83 / $2,157.83
| Facility | | $2,157.83 | $2,157.83 | $2,157.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $759.56 / $999.24 / $1,316.26
| Professional | | $759.56 | $999.24 | $1,316.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,364.00 / $7,664.00 / $36,803.00
| Facility | | $2,364.00 | $7,664.00 | $36,803.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $640.12 / $902.99 / $1,301.70
| Professional | | $640.12 | $902.99 | $1,301.70 |