- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $957.34 / $1,904.11 / $2,579.09
| Facility | | $957.34 | $1,904.11 | $2,579.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $685.48 / $1,200.00 / $1,200.00
| Professional | | $685.48 | $1,200.00 | $1,200.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $989.07 / $2,353.83 / $2,920.48
| Facility | | $989.07 | $2,353.83 | $2,920.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $507.76 / $846.27 / $3,355.99
| Professional | | $507.76 | $846.27 | $3,355.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,345.01 / $1,923.36 / $3,362.53
| Facility | | $1,345.01 | $1,923.36 | $3,362.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $364.13 / $364.13 / $837.81
| Professional | | $364.13 | $364.13 | $837.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $515.36 / $922.58 / $1,925.28
| Facility | | $515.36 | $922.58 | $1,925.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $507.70 / $892.68 / $2,205.76
| Professional | | $507.70 | $892.68 | $2,205.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $83.43 / $4,618.00 / $9,239.00
| Facility | | $83.43 | $4,618.00 | $9,239.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,221.01 / $1,221.01 / $1,436.48
| Professional | | $1,221.01 | $1,221.01 | $1,436.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $846.27 / $846.27 / $2,620.81
| Professional | | $846.27 | $846.27 | $2,620.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,472.51 / $4,614.88 / $4,614.88
| Facility | | $1,472.51 | $4,614.88 | $4,614.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $507.76 / $507.76 / $4,231.35
| Professional | | $507.76 | $507.76 | $4,231.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $507.76 / $687.36 / $1,780.12
| Professional | | $507.76 | $687.36 | $1,780.12 |