- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $501.19 / $3,090.30 / $5,128.61
| Facility | | $501.19 | $3,090.30 | $5,128.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $309.03 / $380.19 / $933.25
| Professional | | $309.03 | $380.19 | $933.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $794.33 / $2,818.38 / $45,708.82
| Facility | | $794.33 | $2,818.38 | $45,708.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $323.59 / $549.54 / $4,786.30
| Professional | | $323.59 | $549.54 | $4,786.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $426.58 / $724.44 / $977.24
| Professional | | $426.58 | $724.44 | $977.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.81 / $549.54 / $1,000.00
| Professional | | $354.81 | $549.54 | $1,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $331.13 / $707.95 / $7,079.46
| Facility | | $331.13 | $707.95 | $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
- $1,096.48 / $2,511.89 / $7,079.46
| Facility | | $1,096.48 | $2,511.89 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $338.84 / $630.96 / $1,023.29
| Professional | | $338.84 | $630.96 | $1,023.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,187.76 / $2,187.76 / $2,187.76
| Facility | | $2,187.76 | $2,187.76 | $2,187.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $812.83 / $2,818.38 / $45,708.82
| Facility | | $812.83 | $2,818.38 | $45,708.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $323.59 / $549.54 / $4,786.30
| Professional | | $323.59 | $549.54 | $4,786.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,047.13 / $2,511.89 / $6,165.95
| Facility | | $1,047.13 | $2,511.89 | $6,165.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.74 / $549.54 / $1,047.13
| Professional | | $346.74 | $549.54 | $1,047.13 |