- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $992.37 / $5,309.69 / $9,412.04
| Facility | | $992.37 | $5,309.69 | $9,412.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $842.36 / $983.41 / $1,865.67
| Professional | | $842.36 | $983.41 | $1,865.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,153.00 / $7,363.00 / $9,410.00
| Facility | | $6,153.00 | $7,363.00 | $9,410.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $826.40 / $1,056.78 / $1,449.37
| Professional | | $826.40 | $1,056.78 | $1,449.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $969.58 / $1,433.48 / $5,895.00
| Professional | | $969.58 | $1,433.48 | $5,895.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $882.83 / $1,162.21 / $2,160.06
| Professional | | $882.83 | $1,162.21 | $2,160.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $842.25 / $1,010.70 / $1,246.53
| Professional | | $842.25 | $1,010.70 | $1,246.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $981.36 / $1,191.61 / $1,745.56
| Facility | | $981.36 | $1,191.61 | $1,745.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,090.95 / $1,247.00 / $2,101.06
| Professional | | $1,090.95 | $1,247.00 | $2,101.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $884.64 / $1,164.13 / $6,585.00
| Facility | | $884.64 | $1,164.13 | $6,585.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $884.64 / $1,164.13 / $6,585.00
| Professional | | $884.64 | $1,164.13 | $6,585.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,693.00 / $11,671.00 / $21,639.00
| Facility | | $6,693.00 | $11,671.00 | $21,639.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $717.00 / $1,154.06 / $1,909.58
| Professional | | $717.00 | $1,154.06 | $1,909.58 |