- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,698.24 / $3,090.30 / $6,760.83
| Facility | | $1,698.24 | $3,090.30 | $6,760.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.74 / $1,258.93 / $2,344.23
| Professional | | $346.74 | $1,258.93 | $2,344.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $288.40 / $288.40 / $331.13
| Professional | | $288.40 | $288.40 | $331.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $79.43 / $257.04 / $380.19
| Facility | | $79.43 | $257.04 | $380.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.74 / $1,000.00 / $2,398.83
| Professional | | $346.74 | $1,000.00 | $2,398.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $602.56 / $602.56 / $602.56
| Facility | | $602.56 | $602.56 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $371.54 / $1,023.29 / $2,630.27
| Professional | | $371.54 | $1,023.29 | $2,630.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $363.08 / $1,412.54 / $4,265.80
| Facility | | $363.08 | $1,412.54 | $4,265.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,445.44 / $2,238.72 / $10,000.00
| Professional | | $1,445.44 | $2,238.72 | $10,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,691.53 / $4,073.80 / $7,244.36
| Facility | | $2,691.53 | $4,073.80 | $7,244.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $363.08 / $1,230.27 / $2,398.83
| Professional | | $363.08 | $1,230.27 | $2,398.83 |