- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $512.86 / $6,165.95 / $11,220.18
| Facility | | $512.86 | $6,165.95 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.81 / $707.95 / $1,698.24
| Professional | | $354.81 | $707.95 | $1,698.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.42 / $363.08 / $645.65
| Professional | | $275.42 | $363.08 | $645.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,715.35 / $13,803.84 / $19,054.61
| Facility | | $3,715.35 | $13,803.84 | $19,054.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $323.59 / $758.58 / $2,290.87
| Professional | | $323.59 | $758.58 | $2,290.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $302.00 / $371.54 / $407.38
| Facility | | $302.00 | $371.54 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $851.14 / $954.99 / $1,949.84
| Professional | | $851.14 | $954.99 | $1,949.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $363.08 / $1,122.02 / $2,344.23
| Facility | | $363.08 | $1,122.02 | $2,344.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $371.54 / $1,000.00 / $1,949.84
| Professional | | $371.54 | $1,000.00 | $1,949.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,630.27 / $7,762.47 / $10,964.78
| Facility | | $2,630.27 | $7,762.47 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $338.84 / $870.96 / $1,905.46
| Professional | | $338.84 | $870.96 | $1,905.46 |