- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,096.48 / $3,801.89 / $5,495.41
| Facility | | $1,096.48 | $3,801.89 | $5,495.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $363.08 / $831.76 / $2,290.87
| Professional | | $363.08 | $831.76 | $2,290.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,174.90 / $3,311.31 / $8,317.64
| Facility | | $1,174.90 | $3,311.31 | $8,317.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $741.31 / $1,513.56 / $1,862.09
| Professional | | $741.31 | $1,513.56 | $1,862.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $398.11 / $707.95 / $1,698.24
| Professional | | $398.11 | $707.95 | $1,698.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $371.54 / $1,000.00 / $3,019.95
| Facility | | $371.54 | $1,000.00 | $3,019.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $436.52 / $1,023.29 / $1,905.46
| Professional | | $436.52 | $1,023.29 | $1,905.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.20 / $30.20 / $77.62
| Professional | | $30.20 | $30.20 | $77.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,248.07 / $7,244.36 / $10,232.93
| Facility | | $5,248.07 | $7,244.36 | $10,232.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $457.09 / $870.96 / $1,995.26
| Professional | | $457.09 | $870.96 | $1,995.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $645.65 / $870.96 / $5,888.44
| Professional | | $645.65 | $870.96 | $5,888.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,467.37 / $6,165.95 / $7,762.47
| Facility | | $3,467.37 | $6,165.95 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $363.08 / $741.31 / $1,659.59
| Professional | | $363.08 | $741.31 | $1,659.59 |