- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,318.26 / $3,388.44 / $5,623.41
| Facility | | $1,318.26 | $3,388.44 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,148.15 / $1,380.38 / $3,981.07
| Professional | | $1,148.15 | $1,380.38 | $3,981.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $2,951.21 / $7,244.36
| Facility | | $56.23 | $2,951.21 | $7,244.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $977.24 / $1,905.46 / $15,135.61
| Professional | | $977.24 | $1,905.46 | $15,135.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,318.26 / $2,398.83 / $4,466.84
| Professional | | $1,318.26 | $2,398.83 | $4,466.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $302.00 / $1,905.46 / $8,511.38
| Facility | | $302.00 | $1,905.46 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $691.83 / $1,318.26 / $1,949.84
| Professional | | $691.83 | $1,318.26 | $1,949.84 |
- 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
- $1,174.90 / $2,089.30 / $3,090.30
| Professional | | $1,174.90 | $2,089.30 | $3,090.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $2,951.21 / $7,244.36
| Facility | | $56.23 | $2,951.21 | $7,244.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $977.24 / $1,862.09 / $15,135.61
| Professional | | $977.24 | $1,862.09 | $15,135.61 |
- 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
- $1,348.96 / $1,949.84 / $3,630.78
| Professional | | $1,348.96 | $1,949.84 | $3,630.78 |