- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,513.56 / $2,884.03 / $5,128.61
| Facility | | $1,513.56 | $2,884.03 | $5,128.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $91.20 / $1,000.00 / $2,951.21
| Professional | | $91.20 | $1,000.00 | $2,951.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $630.96 / $2,238.72 / $17,782.79
| Facility | | $630.96 | $2,238.72 | $17,782.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.71 / $1,862.09 / $8,912.51
| Professional | | $104.71 | $1,862.09 | $8,912.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $107.15 / $107.15 / $251.19
| Facility | | $107.15 | $107.15 | $251.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $83.18 / $134.90 / $8,511.38
| Facility | | $83.18 | $134.90 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7,244.36 / $8,912.51 / $12,589.25
| Professional | | $7,244.36 | $8,912.51 | $12,589.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $630.96 / $2,041.74 / $3,467.37
| Facility | | $630.96 | $2,041.74 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.00 / $1,202.26 / $15,135.61
| Professional | | $100.00 | $1,202.26 | $15,135.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $741.31 / $2,238.72 / $17,782.79
| Facility | | $741.31 | $2,238.72 | $17,782.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.71 / $1,778.28 / $8,912.51
| Professional | | $104.71 | $1,778.28 | $8,912.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $630.96 / $2,041.74 / $7,244.36
| Facility | | $630.96 | $2,041.74 | $7,244.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $107.15 / $1,174.90 / $9,120.11
| Professional | | $107.15 | $1,174.90 | $9,120.11 |