- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,120.00 / $6,166.02 / $13,841.56
| Facility | | $1,120.00 | $6,166.02 | $13,841.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $293.45 / $574.05 / $1,269.33
| Professional | | $293.45 | $574.05 | $1,269.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $323.26 / $702.64 / $1,331.18
| Professional | | $323.26 | $702.64 | $1,331.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,949.61 / $3,879.54 / $7,504.28
| Facility | | $2,949.61 | $3,879.54 | $7,504.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $312.31 / $603.32 / $1,159.63
| Professional | | $312.31 | $603.32 | $1,159.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,257.44 / $1,257.44 / $1,257.44
| Facility | | $1,257.44 | $1,257.44 | $1,257.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $601.57 / $981.30 / $1,669.18
| Professional | | $601.57 | $981.30 | $1,669.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $366.81 / $756.32 / $1,992.24
| Facility | | $366.81 | $756.32 | $1,992.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $693.42 / $1,146.81 / $2,386.48
| Professional | | $693.42 | $1,146.81 | $2,386.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $729.17 / $1,257.44 / $1,677.79
| Facility | | $729.17 | $1,257.44 | $1,677.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $668.92 / $1,011.00 / $1,655.68
| Professional | | $668.92 | $1,011.00 | $1,655.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,679.00 / $3,167.00 / $7,772.00
| Facility | | $2,679.00 | $3,167.00 | $7,772.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $693.42 / $1,040.13 / $1,493.52
| Professional | | $693.42 | $1,040.13 | $1,493.52 |