- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,346.37 / $4,790.00 / $11,576.00
| Facility | | $1,346.37 | $4,790.00 | $11,576.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,347.50 / $1,644.51 / $2,444.84
| Professional | | $1,347.50 | $1,644.51 | $2,444.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $400.00 / $500.00 / $5,047.64
| Facility | | $400.00 | $500.00 | $5,047.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,374.81 / $2,103.40 / $3,272.49
| Professional | | $1,374.81 | $2,103.40 | $3,272.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,624.00 / $21,162.00 / $32,051.00
| Facility | | $9,624.00 | $21,162.00 | $32,051.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $742.45 / $1,347.86 / $2,011.84
| Professional | | $742.45 | $1,347.86 | $2,011.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $181.60 / $1,380.37 / $2,210.16
| Professional | | $181.60 | $1,380.37 | $2,210.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $573.00 / $4,414.00 / $9,150.00
| Facility | | $573.00 | $4,414.00 | $9,150.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,285.82 / $1,762.29 / $3,167.87
| Professional | | $1,285.82 | $1,762.29 | $3,167.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,275.59 / $1,275.59 / $1,275.59
| Professional | | $1,275.59 | $1,275.59 | $1,275.59 |