- 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 / $1,174.90 / $3,801.89
| Professional | | $1,023.29 | $1,174.90 | $3,801.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $3,090.30 / $11,220.18
| Facility | | $56.23 | $3,090.30 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,000.00 / $1,698.24 / $10,232.93
| Professional | | $1,000.00 | $1,698.24 | $10,232.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,148.15 / $1,862.09 / $3,981.07
| Professional | | $1,148.15 | $1,862.09 | $3,981.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $302.00 / $1,862.09 / $8,511.38
| Facility | | $302.00 | $1,862.09 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $676.08 / $1,258.93 / $1,905.46
| Professional | | $676.08 | $1,258.93 | $1,905.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,137.96 / $5,248.07 / $11,220.18
| Facility | | $2,137.96 | $5,248.07 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,148.15 / $2,041.74 / $3,019.95
| Professional | | $1,148.15 | $2,041.74 | $3,019.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $3,235.94 / $12,302.69
| Facility | | $56.23 | $3,235.94 | $12,302.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,000.00 / $1,698.24 / $10,232.93
| Professional | | $1,000.00 | $1,698.24 | $10,232.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,041.74 / $4,570.88 / $9,332.54
| Facility | | $2,041.74 | $4,570.88 | $9,332.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,318.26 / $1,737.80 / $3,467.37
| Professional | | $1,318.26 | $1,737.80 | $3,467.37 |