- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,778.28 / $3,311.31 / $5,128.61
| Facility | | $1,778.28 | $3,311.31 | $5,128.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $602.56 / $741.31 / $1,819.70
| Professional | | $602.56 | $741.31 | $1,819.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,621.81 / $5,623.41 / $45,708.82
| Facility | | $1,621.81 | $5,623.41 | $45,708.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $616.60 / $1,096.48 / $5,011.87
| Professional | | $616.60 | $1,096.48 | $5,011.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $616.60 / $1,071.52 / $1,905.46
| Professional | | $616.60 | $1,071.52 | $1,905.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.44 / $1,584.89 / $7,079.46
| Facility | | $575.44 | $1,584.89 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $794.33 / $1,000.00 / $1,348.96
| Professional | | $794.33 | $1,000.00 | $1,348.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,137.96 / $5,248.07 / $11,220.18
| Facility | | $2,137.96 | $5,248.07 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $707.95 / $1,318.26 / $2,089.30
| Professional | | $707.95 | $1,318.26 | $2,089.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,659.59 / $5,623.41 / $45,708.82
| Facility | | $1,659.59 | $5,623.41 | $45,708.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $616.60 / $1,096.48 / $5,011.87
| Professional | | $616.60 | $1,096.48 | $5,011.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,041.74 / $5,248.07 / $10,715.19
| Facility | | $2,041.74 | $5,248.07 | $10,715.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $691.83 / $1,071.52 / $2,187.76
| Professional | | $691.83 | $1,071.52 | $2,187.76 |