- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $426.58 / $2,818.38 / $5,128.61
| Facility | | $426.58 | $2,818.38 | $5,128.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $251.19 / $398.11 / $831.76
| Professional | | $251.19 | $398.11 | $831.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $602.56 / $4,897.79 / $28,840.32
| Facility | | $602.56 | $4,897.79 | $28,840.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.84 / $524.81 / $1,258.93
| Professional | | $281.84 | $524.81 | $1,258.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $302.00 / $302.00 / $691.83
| Facility | | $302.00 | $302.00 | $691.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.84 / $537.03 / $977.24
| Professional | | $281.84 | $537.03 | $977.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $251.19 / $537.03 / $7,079.46
| Facility | | $251.19 | $537.03 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $436.52 / $549.54 / $776.25
| Professional | | $436.52 | $549.54 | $776.25 |
- 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
- $295.12 / $524.81 / $1,000.00
| Professional | | $295.12 | $524.81 | $1,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $602.56 / $4,897.79 / $28,840.32
| Facility | | $602.56 | $4,897.79 | $28,840.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $288.40 / $524.81 / $1,258.93
| Professional | | $288.40 | $524.81 | $1,258.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,862.09 / $4,265.80 / $9,772.37
| Facility | | $1,862.09 | $4,265.80 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $316.23 / $549.54 / $1,023.29
| Professional | | $316.23 | $549.54 | $1,023.29 |