- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,392.00 / $5,511.00 / $16,900.00
| Facility | | $1,392.00 | $5,511.00 | $16,900.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $710.25 / $838.95 / $1,009.73
| Professional | | $710.25 | $838.95 | $1,009.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $777.38 / $1,030.89 / $1,380.57
| Professional | | $777.38 | $1,030.89 | $1,380.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,321.00 / $2,321.00 / $2,321.00
| Facility | | $2,321.00 | $2,321.00 | $2,321.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $765.17 / $1,004.86 / $1,304.79
| Professional | | $765.17 | $1,004.86 | $1,304.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $748.76 / $1,076.96 / $5,991.35
| Facility | | $748.76 | $1,076.96 | $5,991.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $693.90 / $945.42 / $5,623.04
| Professional | | $693.90 | $945.42 | $5,623.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $350.00 / $1,760.00 / $6,155.68
| Facility | | $350.00 | $1,760.00 | $6,155.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $677.57 / $858.25 / $1,298.98
| Professional | | $677.57 | $858.25 | $1,298.98 |