- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,884.03 / $4,466.84 / $5,495.41
| Facility | | $2,884.03 | $4,466.84 | $5,495.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $537.03 / $776.25 / $1,230.27
| Professional | | $537.03 | $776.25 | $1,230.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,202.26 / $2,344.23 / $4,786.30
| Facility | | $1,202.26 | $2,344.23 | $4,786.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,000.00 / $1,148.15 / $1,202.26
| Professional | | $1,000.00 | $1,148.15 | $1,202.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,174.90 / $1,174.90 / $1,174.90
| Facility | | $1,174.90 | $1,174.90 | $1,174.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $588.84 / $776.25 / $1,023.29
| Professional | | $588.84 | $776.25 | $1,023.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $588.84 / $933.25 / $1,513.56
| Facility | | $588.84 | $933.25 | $1,513.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $933.25 / $1,071.52 / $1,445.44
| Professional | | $933.25 | $1,071.52 | $1,445.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $32.36 / $33.11
| Professional | | $32.36 | $32.36 | $33.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,311.31 / $4,073.80 / $6,025.60
| Facility | | $3,311.31 | $4,073.80 | $6,025.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $831.76 / $1,148.15 / $1,288.25
| Professional | | $831.76 | $1,148.15 | $1,288.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $524.81 / $691.83 / $3,715.35
| Professional | | $524.81 | $691.83 | $3,715.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $676.08 / $3,467.37 / $7,762.47
| Facility | | $676.08 | $3,467.37 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $602.56 / $870.96 / $1,230.27
| Professional | | $602.56 | $870.96 | $1,230.27 |