- 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
- $89.13 / $165.96 / $588.84
| Professional | | $89.13 | $165.96 | $588.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $316.23 / $8,317.64 / $45,708.82
| Facility | | $316.23 | $8,317.64 | $45,708.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.00 / $208.93 / $2,089.30
| Professional | | $100.00 | $208.93 | $2,089.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $181.97 / $281.84 / $478.63
| Professional | | $181.97 | $281.84 | $478.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $123.03 / $575.44 / $7,079.46
| Facility | | $123.03 | $575.44 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $141.25 / $173.78 / $323.59
| Professional | | $141.25 | $173.78 | $323.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,570.40 / $6,918.31 / $15,488.17
| Facility | | $2,570.40 | $6,918.31 | $15,488.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $125.89 / $223.87 / $416.87
| Professional | | $125.89 | $223.87 | $416.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $316.23 / $8,709.64 / $45,708.82
| Facility | | $316.23 | $8,709.64 | $45,708.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.00 / $208.93 / $2,089.30
| Professional | | $100.00 | $208.93 | $2,089.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,570.40 / $7,244.36 / $15,488.17
| Facility | | $2,570.40 | $7,244.36 | $15,488.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $154.88 / $234.42 / $549.54
| Professional | | $154.88 | $234.42 | $549.54 |