- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $977.24 / $1,047.13 / $1,288.25
| Facility | | $977.24 | $1,047.13 | $1,288.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $912.01 / $1,230.27 / $3,090.30
| Professional | | $912.01 | $1,230.27 | $3,090.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $870.96 / $1,230.27 / $1,995.26
| Professional | | $870.96 | $1,230.27 | $1,995.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $34.67 / $323.59 / $1,995.26
| Facility | | $34.67 | $323.59 | $1,995.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,000.00 / $1,513.56 / $2,754.23
| Professional | | $1,000.00 | $1,513.56 | $2,754.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,348.96 / $2,630.27 / $6,456.54
| Facility | | $1,348.96 | $2,630.27 | $6,456.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $812.83 / $870.96 / $1,122.02
| Professional | | $812.83 | $870.96 | $1,122.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $33.11 / $1,584.89
| Professional | | $32.36 | $33.11 | $1,584.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,071.52 / $5,370.32 / $11,481.54
| Facility | | $1,071.52 | $5,370.32 | $11,481.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $933.25 / $1,318.26 / $2,290.87
| Professional | | $933.25 | $1,318.26 | $2,290.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $870.96 / $870.96 / $1,174.90
| Professional | | $870.96 | $870.96 | $1,174.90 |