- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,459.96 / $4,908.00 / $12,174.00
| Facility | | $1,459.96 | $4,908.00 | $12,174.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,164.75 / $1,447.48 / $1,477.86
| Professional | | $1,164.75 | $1,447.48 | $1,477.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $862.00 / $2,251.00 / $7,568.22
| Facility | | $862.00 | $2,251.00 | $7,568.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,280.39 / $1,546.71 / $2,490.15
| Professional | | $1,280.39 | $1,546.71 | $2,490.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,131.96 / $1,822.29 / $3,343.04
| Professional | | $1,131.96 | $1,822.29 | $3,343.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $325.13 / $1,770.27 / $3,179.77
| Facility | | $325.13 | $1,770.27 | $3,179.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,433.81 / $2,322.05 / $10,527.44
| Professional | | $1,433.81 | $2,322.05 | $10,527.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $325.13 / $1,398.00 / $2,087.00
| Facility | | $325.13 | $1,398.00 | $2,087.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,371.30 / $1,909.03 / $3,518.66
| Professional | | $1,371.30 | $1,909.03 | $3,518.66 |