- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,621.81 / $4,466.84 / $5,495.41
| Facility | | $1,621.81 | $4,466.84 | $5,495.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $363.08 / $645.65 / $1,148.15
| Professional | | $363.08 | $645.65 | $1,148.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,548.82 / $3,388.44 / $6,025.60
| Facility | | $1,548.82 | $3,388.44 | $6,025.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $575.44 / $794.33 / $1,023.29
| Professional | | $575.44 | $794.33 | $1,023.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.42 / $562.34 / $891.25
| Professional | | $275.42 | $562.34 | $891.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $223.87 / $537.03 / $1,621.81
| Facility | | $223.87 | $537.03 | $1,621.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $389.05 / $602.56 / $1,000.00
| Professional | | $389.05 | $602.56 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $32.36 / $33.11
| Professional | | $32.36 | $32.36 | $33.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,981.07 / $5,248.07 / $7,413.10
| Facility | | $3,981.07 | $5,248.07 | $7,413.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $588.84 / $741.31 / $1,122.02
| Professional | | $588.84 | $741.31 | $1,122.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $467.74 / $676.08 / $4,365.16
| Professional | | $467.74 | $676.08 | $4,365.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,148.15 / $5,495.41 / $12,302.69
| Facility | | $1,148.15 | $5,495.41 | $12,302.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $380.19 / $562.34 / $912.01
| Professional | | $380.19 | $562.34 | $912.01 |