- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,174.90 / $3,388.44 / $5,623.41
| Facility | | $1,174.90 | $3,388.44 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,023.29 / $1,202.26 / $3,548.13
| Professional | | $1,023.29 | $1,202.26 | $3,548.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $2,691.53 / $7,244.36
| Facility | | $56.23 | $2,691.53 | $7,244.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $870.96 / $1,659.59 / $8,317.64
| Professional | | $870.96 | $1,659.59 | $8,317.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,174.90 / $2,089.30 / $3,981.07
| Professional | | $1,174.90 | $2,089.30 | $3,981.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $812.83 / $1,995.26 / $7,079.46
| Facility | | $812.83 | $1,995.26 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $616.60 / $1,174.90 / $1,737.80
| Professional | | $616.60 | $1,174.90 | $1,737.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $3,311.31 / $5,888.44
| Facility | | $1,000.00 | $3,311.31 | $5,888.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,047.13 / $1,862.09 / $2,754.23
| Professional | | $1,047.13 | $1,862.09 | $2,754.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $2,691.53 / $7,244.36
| Facility | | $56.23 | $2,691.53 | $7,244.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $870.96 / $1,659.59 / $8,317.64
| Professional | | $870.96 | $1,659.59 | $8,317.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $954.99 / $2,884.03 / $4,677.35
| Facility | | $954.99 | $2,884.03 | $4,677.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,174.90 / $1,698.24 / $3,162.28
| Professional | | $1,174.90 | $1,698.24 | $3,162.28 |