- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,202.26 / $4,365.16 / $7,943.28
| Facility | | $1,202.26 | $4,365.16 | $7,943.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $436.52 / $575.44 / $1,174.90
| Professional | | $436.52 | $575.44 | $1,174.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $389.05 / $562.34 / $933.25
| Professional | | $389.05 | $562.34 | $933.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,071.52 / $2,754.23 / $6,025.60
| Facility | | $1,071.52 | $2,754.23 | $6,025.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $467.74 / $741.31 / $1,000.00
| Professional | | $467.74 | $741.31 | $1,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,089.30 / $2,089.30 / $2,089.30
| Facility | | $2,089.30 | $2,089.30 | $2,089.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $436.52 / $758.58 / $1,230.27
| Professional | | $436.52 | $758.58 | $1,230.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $426.58 / $549.54 / $2,137.96
| Professional | | $426.58 | $549.54 | $2,137.96 |
- Facility/Professional
- Professional
- Modifier
- 22
- Low / Median / High Price
- $1,122.02 / $1,122.02 / $1,122.02
| Professional | 22 | $1,122.02 | $1,122.02 | $1,122.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,122.02 / $4,168.69 / $6,918.31
| Facility | | $1,122.02 | $4,168.69 | $6,918.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $478.63 / $645.65 / $1,174.90
| Professional | | $478.63 | $645.65 | $1,174.90 |