- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,148.15 / $2,818.38 / $5,128.61
| Facility | | $1,148.15 | $2,818.38 | $5,128.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.81 / $616.60 / $1,202.26
| Professional | | $354.81 | $616.60 | $1,202.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $851.14 / $7,079.46 / $28,840.32
| Facility | | $851.14 | $7,079.46 | $28,840.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $398.11 / $758.58 / $1,905.46
| Professional | | $398.11 | $758.58 | $1,905.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $436.52 / $436.52 / $1,000.00
| Facility | | $436.52 | $436.52 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $389.05 / $831.76 / $1,621.81
| Professional | | $389.05 | $831.76 | $1,621.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $338.84 / $741.31 / $7,079.46
| Facility | | $338.84 | $741.31 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $741.31 / $912.01 / $1,318.26
| Professional | | $741.31 | $912.01 | $1,318.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,511.89 / $6,165.95 / $13,182.57
| Facility | | $2,511.89 | $6,165.95 | $13,182.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $398.11 / $758.58 / $1,621.81
| Professional | | $398.11 | $758.58 | $1,621.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $851.14 / $7,079.46 / $28,840.32
| Facility | | $851.14 | $7,079.46 | $28,840.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $398.11 / $758.58 / $1,905.46
| Professional | | $398.11 | $758.58 | $1,905.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,511.89 / $6,309.57 / $13,803.84
| Facility | | $2,511.89 | $6,309.57 | $13,803.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $407.38 / $794.33 / $1,659.59
| Professional | | $407.38 | $794.33 | $1,659.59 |