- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $351.11 / $2,747.00 / $7,920.26
| Facility | | $351.11 | $2,747.00 | $7,920.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $225.56 / $655.59 / $1,742.63
| Professional | | $225.56 | $655.59 | $1,742.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $300.04 / $755.97 / $2,060.42
| Professional | | $300.04 | $755.97 | $2,060.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $326.86 / $673.28 / $1,767.05
| Professional | | $326.86 | $673.28 | $1,767.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $226.77 / $673.28 / $1,722.74
| Facility | | $226.77 | $673.28 | $1,722.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $277.52 / $998.58 / $2,250.31
| Professional | | $277.52 | $998.58 | $2,250.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $362.52 / $1,224.08 / $1,494.77
| Facility | | $362.52 | $1,224.08 | $1,494.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $264.08 / $1,234.54 / $2,570.48
| Facility | | $264.08 | $1,234.54 | $2,570.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $331.52 / $918.23 / $2,048.73
| Professional | | $331.52 | $918.23 | $2,048.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,273.56 / $9,753.18 / $13,050.49
| Facility | | $5,273.56 | $9,753.18 | $13,050.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $331.47 / $589.92 / $2,133.77
| Professional | | $331.47 | $589.92 | $2,133.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,981.00 / $9,074.00 / $12,786.00
| Facility | | $1,981.00 | $9,074.00 | $12,786.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,146.27 / $1,720.09 / $2,395.90
| Professional | | $1,146.27 | $1,720.09 | $2,395.90 |