- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $366.02 / $3,924.92 / $7,920.26
| Facility | | $366.02 | $3,924.92 | $7,920.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $193.91 / $703.13 / $1,321.76
| Professional | | $193.91 | $703.13 | $1,321.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $312.29 / $596.10 / $2,107.73
| Professional | | $312.29 | $596.10 | $2,107.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $341.56 / $500.61 / $1,837.01
| Professional | | $341.56 | $500.61 | $1,837.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $245.87 / $698.67 / $1,990.18
| Facility | | $245.87 | $698.67 | $1,990.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $299.88 / $1,174.72 / $2,238.71
| Professional | | $299.88 | $1,174.72 | $2,238.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $357.22 / $1,346.03 / $1,547.00
| Facility | | $357.22 | $1,346.03 | $1,547.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $245.87 / $1,495.15 / $3,601.00
| Facility | | $245.87 | $1,495.15 | $3,601.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $344.32 / $903.23 / $2,230.75
| Professional | | $344.32 | $903.23 | $2,230.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,811.13 / $10,179.44 / $11,932.41
| Facility | | $7,811.13 | $10,179.44 | $11,932.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $348.30 / $619.88 / $2,222.84
| Professional | | $348.30 | $619.88 | $2,222.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,155.00 / $12,835.00 / $26,404.00
| Facility | | $2,155.00 | $12,835.00 | $26,404.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,191.32 / $1,596.52 / $2,495.89
| Professional | | $1,191.32 | $1,596.52 | $2,495.89 |