- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.44 / $5,011.87 / $8,317.64
| Facility | | $575.44 | $5,011.87 | $8,317.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $457.09 / $549.54 / $1,000.00
| Professional | | $457.09 | $549.54 | $1,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,888.44 / $6,760.83 / $7,413.10
| Facility | | $5,888.44 | $6,760.83 | $7,413.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $501.19 / $676.08 / $954.99
| Professional | | $501.19 | $676.08 | $954.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $549.54 / $851.14 / $5,495.41
| Professional | | $549.54 | $851.14 | $5,495.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $467.74 / $616.60 / $1,096.48
| Professional | | $467.74 | $616.60 | $1,096.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $501.19 / $616.60 / $1,584.89
| Professional | | $501.19 | $616.60 | $1,584.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $602.56 / $758.58 / $1,202.26
| Professional | | $602.56 | $758.58 | $1,202.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $537.03 / $691.83 / $1,023.29
| Facility | | $537.03 | $691.83 | $1,023.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $446.68 / $676.08 / $8,709.64
| Facility | | $446.68 | $676.08 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $446.68 / $676.08 / $8,709.64
| Professional | | $446.68 | $676.08 | $8,709.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,890.45 / $7,244.36 / $14,125.38
| Facility | | $3,890.45 | $7,244.36 | $14,125.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $389.05 / $602.56 / $1,047.13
| Professional | | $389.05 | $602.56 | $1,047.13 |