- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,741.00 / $10,793.00 / $14,552.94
| Facility | | $3,741.00 | $10,793.00 | $14,552.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $345.35 / $407.01 / $2,052.27
| Professional | | $345.35 | $407.01 | $2,052.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,251.08 / $1,251.08 / $1,251.08
| Professional | | $1,251.08 | $1,251.08 | $1,251.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $449.58 / $2,052.27 / $2,934.75
| Facility | | $449.58 | $2,052.27 | $2,934.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $897.63 / $2,331.00 / $2,948.21
| Professional | | $897.63 | $2,331.00 | $2,948.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,387.50 / $1,609.50 / $2,415.09
| Professional | | $1,387.50 | $1,609.50 | $2,415.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $449.58 / $2,052.27 / $2,934.75
| Facility | | $449.58 | $2,052.27 | $2,934.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $360.10 / $1,629.00 / $2,490.75
| Professional | | $360.10 | $1,629.00 | $2,490.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,000.86 / $1,006.56 / $2,315.09
| Professional | | $1,000.86 | $1,006.56 | $2,315.09 |