- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,513.56 / $2,818.38 / $5,128.61
| Facility | | $1,513.56 | $2,818.38 | $5,128.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $524.81 / $616.60 / $1,862.09
| Professional | | $524.81 | $616.60 | $1,862.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $1,905.46 / $19,952.62
| Facility | | $56.23 | $1,905.46 | $19,952.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $436.52 / $851.14 / $4,168.69
| Professional | | $436.52 | $851.14 | $4,168.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $616.60 / $1,071.52 / $1,995.26
| Professional | | $616.60 | $1,071.52 | $1,995.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $302.00 / $851.14 / $8,511.38
| Facility | | $302.00 | $851.14 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $309.03 / $588.84 / $870.96
| Professional | | $309.03 | $588.84 | $870.96 |
- 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
- $562.34 / $1,000.00 / $1,584.89
| Professional | | $562.34 | $1,000.00 | $1,584.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $1,949.84 / $19,952.62
| Facility | | $56.23 | $1,949.84 | $19,952.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $436.52 / $851.14 / $4,168.69
| Professional | | $436.52 | $851.14 | $4,168.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,047.13 / $2,511.89 / $12,589.25
| Facility | | $1,047.13 | $2,511.89 | $12,589.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $616.60 / $912.01 / $2,089.30
| Professional | | $616.60 | $912.01 | $2,089.30 |