- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,050.74 / $1,475.00 / $3,120.69
| Facility | | $1,050.74 | $1,475.00 | $3,120.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $264.14 / $1,050.74 / $1,387.20
| Professional | | $264.14 | $1,050.74 | $1,387.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $272.18 / $272.18 / $272.18
| Professional | | $272.18 | $272.18 | $272.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $109.97 / $334.42 / $2,278.87
| Facility | | $109.97 | $334.42 | $2,278.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.66 / $1,013.41 / $1,013.41
| Professional | | $0.66 | $1,013.41 | $1,013.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,007.69 / $4,802.60 / $4,802.60
| Facility | | $2,007.69 | $4,802.60 | $4,802.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,050.74 / $1,477.00 / $3,320.34
| Facility | | $1,050.74 | $1,477.00 | $3,320.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $288.00 / $1,037.28 / $1,477.00
| Professional | | $288.00 | $1,037.28 | $1,477.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $373.40 / $373.40 / $373.40
| Professional | | $373.40 | $373.40 | $373.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $79.84 / $334.42 / $3,065.07
| Facility | | $79.84 | $334.42 | $3,065.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,013.41 / $1,013.41 / $1,013.41
| Professional | | $1,013.41 | $1,013.41 | $1,013.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $798.17 / $1,019.88 / $1,676.41
| Professional | | $798.17 | $1,019.88 | $1,676.41 |