- 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
- $436.52 / $562.34 / $1,380.38
| Professional | | $436.52 | $562.34 | $1,380.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $467.74 / $1,348.96 / $28,840.32
| Facility | | $467.74 | $1,348.96 | $28,840.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $467.74 / $776.25 / $3,890.45
| Professional | | $467.74 | $776.25 | $3,890.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $426.58 / $812.83 / $1,513.56
| Professional | | $426.58 | $812.83 | $1,513.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $501.19 / $1,148.15 / $7,079.46
| Facility | | $501.19 | $1,148.15 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $588.84 / $741.31 / $1,000.00
| Professional | | $588.84 | $741.31 | $1,000.00 |
- 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
- $537.03 / $933.25 / $1,380.38
| Professional | | $537.03 | $933.25 | $1,380.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $501.19 / $1,348.96 / $28,840.32
| Facility | | $501.19 | $1,348.96 | $28,840.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $467.74 / $776.25 / $3,890.45
| Professional | | $467.74 | $776.25 | $3,890.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $501.19 / $1,819.70 / $2,818.38
| Facility | | $501.19 | $1,819.70 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $501.19 / $741.31 / $1,548.82
| Professional | | $501.19 | $741.31 | $1,548.82 |