- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,074.00 / $4,422.35 / $5,284.42
| Facility | | $1,074.00 | $4,422.35 | $5,284.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $758.12 / $1,023.46 / $1,074.00
| Professional | | $758.12 | $1,023.46 | $1,074.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $985.55 / $985.55 / $985.55
| Professional | | $985.55 | $985.55 | $985.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $845.93 / $1,642.58 / $4,193.20
| Facility | | $845.93 | $1,642.58 | $4,193.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,090.21 / $6,090.21 / $6,090.21
| Professional | | $6,090.21 | $6,090.21 | $6,090.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,326.71 / $1,705.77 / $3,120.92
| Professional | | $1,326.71 | $1,705.77 | $3,120.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,406.94 / $4,359.93 / $5,284.42
| Facility | | $1,406.94 | $4,359.93 | $5,284.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $829.25 / $1,074.00 / $5,218.38
| Professional | | $829.25 | $1,074.00 | $5,218.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,870.02 / $1,895.30 / $2,527.06
| Professional | | $1,870.02 | $1,895.30 | $2,527.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $845.93 / $1,642.58 / $4,193.20
| Facility | | $845.93 | $1,642.58 | $4,193.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,090.21 / $6,090.21 / $6,090.21
| Professional | | $6,090.21 | $6,090.21 | $6,090.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,263.53 / $1,263.53 / $1,263.53
| Facility | | $1,263.53 | $1,263.53 | $1,263.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,263.53 / $1,263.53 / $1,263.53
| Professional | | $1,263.53 | $1,263.53 | $1,263.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $530.67 / $758.12 / $1,687.07
| Professional | | $530.67 | $758.12 | $1,687.07 |