- 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
- $323.59 / $416.87 / $933.25
| Professional | | $323.59 | $416.87 | $933.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $812.83 / $4,897.79 / $28,840.32
| Facility | | $812.83 | $4,897.79 | $28,840.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $338.84 / $575.44 / $4,677.35
| Professional | | $338.84 | $575.44 | $4,677.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.81 / $562.34 / $954.99
| Professional | | $354.81 | $562.34 | $954.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $331.13 / $691.83 / $7,079.46
| Facility | | $331.13 | $691.83 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $363.08 / $457.09 / $630.96
| Professional | | $363.08 | $457.09 | $630.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,995.26 / $4,265.80 / $9,772.37
| Facility | | $1,995.26 | $4,265.80 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.74 / $645.65 / $1,000.00
| Professional | | $346.74 | $645.65 | $1,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $812.83 / $4,897.79 / $28,840.32
| Facility | | $812.83 | $4,897.79 | $28,840.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $338.84 / $575.44 / $4,677.35
| Professional | | $338.84 | $575.44 | $4,677.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,862.09 / $4,265.80 / $12,302.69
| Facility | | $1,862.09 | $4,265.80 | $12,302.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $389.05 / $616.60 / $1,047.13
| Professional | | $389.05 | $616.60 | $1,047.13 |