- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,093.95 / $2,442.73 / $3,963.96
| Facility | | $1,093.95 | $2,442.73 | $3,963.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $965.25 / $1,055.33 / $1,093.95
| Professional | | $965.25 | $1,055.33 | $1,093.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,287.00 / $1,287.00 / $6,267.69
| Facility | | $1,287.00 | $1,287.00 | $6,267.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $514.79 / $514.79 / $786.35
| Professional | | $514.79 | $514.79 | $786.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,029.59 / $1,158.30 / $2,258.67
| Professional | | $1,029.59 | $1,158.30 | $2,258.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $845.90 / $2,404.85 / $6,592.37
| Facility | | $845.90 | $2,404.85 | $6,592.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $602.94 / $781.23 / $2,124.32
| Professional | | $602.94 | $781.23 | $2,124.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,287.00 / $1,544.40 / $1,904.76
| Professional | | $1,287.00 | $1,544.40 | $1,904.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $772.20 / $1,093.95 / $1,750.32
| Facility | | $772.20 | $1,093.95 | $1,750.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,266.00 / $1,351.35 / $3,088.80
| Professional | | $1,266.00 | $1,351.35 | $3,088.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $900.90 / $1,546.97 / $5,492.14
| Facility | | $900.90 | $1,546.97 | $5,492.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $900.90 / $1,557.78 / $5,492.14
| Professional | | $900.90 | $1,557.78 | $5,492.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $540.54 / $643.50 / $1,287.00
| Professional | | $540.54 | $643.50 | $1,287.00 |