- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $933.25 / $5,011.87 / $12,589.25
| Facility | | $933.25 | $5,011.87 | $12,589.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $363.08 / $489.78 / $2,187.76
| Professional | | $363.08 | $489.78 | $2,187.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,090.30 / $4,073.80 / $7,943.28
| Facility | | $3,090.30 | $4,073.80 | $7,943.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $389.05 / $660.69 / $870.96
| Professional | | $389.05 | $660.69 | $870.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,862.09 / $1,862.09 / $1,862.09
| Facility | | $1,862.09 | $1,862.09 | $1,862.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $851.14 / $1,071.52 / $1,318.26
| Professional | | $851.14 | $1,071.52 | $1,318.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $363.08 / $707.95 / $3,715.35
| Facility | | $363.08 | $707.95 | $3,715.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $616.60 / $912.01 / $2,951.21
| Professional | | $616.60 | $912.01 | $2,951.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $912.01 / $1,047.13 / $1,318.26
| Professional | | $912.01 | $1,047.13 | $1,318.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,862.09 / $1,862.09 / $1,862.09
| Facility | | $1,862.09 | $1,862.09 | $1,862.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $870.96 / $1,000.00 / $1,202.26
| Professional | | $870.96 | $1,000.00 | $1,202.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,630.27 / $3,162.28 / $8,128.31
| Facility | | $2,630.27 | $3,162.28 | $8,128.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $524.81 / $812.83 / $1,071.52
| Professional | | $524.81 | $812.83 | $1,071.52 |