- 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
- $436.52 / $524.81 / $1,348.96
| Professional | | $436.52 | $524.81 | $1,348.96 |
- 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
- $389.05 / $645.65 / $851.14
| Professional | | $389.05 | $645.65 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $457.09 / $588.84 / $891.25
| Professional | | $457.09 | $588.84 | $891.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $630.96 / $630.96 / $707.95
| Professional | | $630.96 | $630.96 | $707.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $467.74 / $602.56 / $1,000.00
| Professional | | $467.74 | $602.56 | $1,000.00 |
- 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
- $467.74 / $588.84 / $1,513.56
| Professional | | $467.74 | $588.84 | $1,513.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $501.19 / $512.86 / $1,071.52
| Professional | | $501.19 | $512.86 | $1,071.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $407.38 / $426.58 / $446.68
| Facility | | $407.38 | $426.58 | $446.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $407.38 / $436.52 / $467.74
| Professional | | $407.38 | $436.52 | $467.74 |
- 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
- $416.87 / $562.34 / $933.25
| Professional | | $416.87 | $562.34 | $933.25 |