- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $662.19 / $2,747.00 / $7,920.26
| Facility | | $662.19 | $2,747.00 | $7,920.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $550.94 / $828.81 / $3,610.00
| Professional | | $550.94 | $828.81 | $3,610.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,664.70 / $1,664.70 / $1,664.70
| Facility | | $1,664.70 | $1,664.70 | $1,664.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $679.39 / $679.39 / $679.39
| Professional | | $679.39 | $679.39 | $679.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,190.08 / $1,562.69 / $1,919.05
| Professional | | $1,190.08 | $1,562.69 | $1,919.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $739.16 / $1,224.83 / $1,706.80
| Facility | | $739.16 | $1,224.83 | $1,706.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,107.71 / $1,255.99 / $2,228.91
| Professional | | $1,107.71 | $1,255.99 | $2,228.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $975.10 / $1,310.52 / $1,520.23
| Facility | | $975.10 | $1,310.52 | $1,520.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $739.16 / $1,341.55 / $1,935.87
| Facility | | $739.16 | $1,341.55 | $1,935.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $770.21 / $1,562.02 / $2,075.52
| Professional | | $770.21 | $1,562.02 | $2,075.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,579.22 / $3,579.22 / $3,579.22
| Facility | | $3,579.22 | $3,579.22 | $3,579.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,221.61 / $1,696.90 / $2,137.56
| Professional | | $1,221.61 | $1,696.90 | $2,137.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,345.00 / $7,664.00 / $31,303.00
| Facility | | $1,345.00 | $7,664.00 | $31,303.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $986.34 / $1,369.20 / $2,354.66
| Professional | | $986.34 | $1,369.20 | $2,354.66 |