- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $363.08 / $1,380.38 / $8,317.64
| Facility | | $363.08 | $1,380.38 | $8,317.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $363.08 / $416.87 / $1,023.29
| Professional | | $363.08 | $416.87 | $1,023.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,630.78 / $4,265.80 / $4,786.30
| Facility | | $3,630.78 | $4,265.80 | $4,786.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $478.63 / $851.14 / $1,174.90
| Professional | | $478.63 | $851.14 | $1,174.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $501.19 / $7,585.78 / $12,589.25
| Facility | | $501.19 | $7,585.78 | $12,589.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $398.11 / $602.56 / $1,000.00
| Professional | | $398.11 | $602.56 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $758.58 / $758.58 / $758.58
| Professional | | $758.58 | $758.58 | $758.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $363.08 / $512.86 / $812.83
| Facility | | $363.08 | $512.86 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $501.19 / $501.19 / $501.19
| Professional | | $501.19 | $501.19 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $562.34 / $676.08 / $891.25
| Professional | | $562.34 | $676.08 | $891.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,737.80 / $8,317.64 / $19,952.62
| Facility | | $1,737.80 | $8,317.64 | $19,952.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $338.84 / $457.09 / $831.76
| Professional | | $338.84 | $457.09 | $831.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $37,153.52 / $37,153.52 / $50,118.72
| Facility | | $37,153.52 | $37,153.52 | $50,118.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,818.38 / $2,818.38 / $3,019.95
| Professional | | $2,818.38 | $2,818.38 | $3,019.95 |