- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,707.47 / $7,119.04 / $19,276.96
| Facility | | $2,707.47 | $7,119.04 | $19,276.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $256.26 / $429.08 / $1,689.00
| Professional | | $256.26 | $429.08 | $1,689.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $456.96 / $456.96 / $456.96
| Professional | | $456.96 | $456.96 | $456.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,442.56 / $3,212.63 / $6,214.26
| Facility | | $2,442.56 | $3,212.63 | $6,214.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $270.16 / $504.77 / $788.73
| Professional | | $270.16 | $504.77 | $788.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $348.36 / $819.70 / $1,221.05
| Professional | | $348.36 | $819.70 | $1,221.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $365.67 / $640.79 / $1,775.00
| Facility | | $365.67 | $640.79 | $1,775.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $504.69 / $861.18 / $5,940.86
| Professional | | $504.69 | $861.18 | $5,940.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $537.54 / $771.48 / $1,143.34
| Facility | | $537.54 | $771.48 | $1,143.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $582.00 / $786.90 / $1,143.34
| Professional | | $582.00 | $786.90 | $1,143.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $290.64 / $488.16 / $843.93
| Professional | | $290.64 | $488.16 | $843.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,031.00 / $1,775.00 / $4,406.00
| Facility | | $1,031.00 | $1,775.00 | $4,406.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $504.69 / $889.22 / $1,019.92
| Professional | | $504.69 | $889.22 | $1,019.92 |