- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $956.28 / $2,747.00 / $7,920.26
| Facility | | $956.28 | $2,747.00 | $7,920.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $495.44 / $634.07 / $2,506.92
| Professional | | $495.44 | $634.07 | $2,506.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $652.91 / $982.85 / $1,411.15
| Professional | | $652.91 | $982.85 | $1,411.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $746.40 / $1,052.43 / $1,198.06
| Professional | | $746.40 | $1,052.43 | $1,198.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $456.40 / $906.72 / $1,363.25
| Facility | | $456.40 | $906.72 | $1,363.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $767.48 / $1,093.08 / $1,525.66
| Professional | | $767.48 | $1,093.08 | $1,525.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $641.59 / $909.24 / $977.84
| Facility | | $641.59 | $909.24 | $977.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $456.40 / $988.83 / $1,363.25
| Facility | | $456.40 | $988.83 | $1,363.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $838.77 / $1,140.83 / $1,479.08
| Professional | | $838.77 | $1,140.83 | $1,479.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,542.92 / $2,542.92 / $2,542.92
| Facility | | $2,542.92 | $2,542.92 | $2,542.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $883.19 / $1,161.86 / $1,530.49
| Professional | | $883.19 | $1,161.86 | $1,530.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,364.00 / $8,571.00 / $36,803.00
| Facility | | $2,364.00 | $8,571.00 | $36,803.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $744.64 / $1,079.27 / $1,527.76
| Professional | | $744.64 | $1,079.27 | $1,527.76 |