- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,089.30 / $3,630.78 / $6,309.57
| Facility | | $2,089.30 | $3,630.78 | $6,309.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $269.15 / $380.19 / $1,412.54
| Professional | | $269.15 | $380.19 | $1,412.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $676.08 / $5,128.61 / $45,708.82
| Facility | | $676.08 | $5,128.61 | $45,708.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $218.78 / $426.58 / $3,467.37
| Professional | | $218.78 | $426.58 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $309.03 / $524.81 / $1,000.00
| Professional | | $309.03 | $524.81 | $1,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $263.03 / $575.44 / $7,079.46
| Facility | | $263.03 | $575.44 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.36 / $295.12 / $436.52
| Professional | | $151.36 | $295.12 | $436.52 |
- 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
- $269.15 / $501.19 / $794.33
| Professional | | $269.15 | $501.19 | $794.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $851.14 / $4,073.80 / $7,244.36
| Facility | | $851.14 | $4,073.80 | $7,244.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $501.19 / $501.19 / $501.19
| Professional | | $501.19 | $501.19 | $501.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $676.08 / $5,370.32 / $45,708.82
| Facility | | $676.08 | $5,370.32 | $45,708.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $218.78 / $426.58 / $3,467.37
| Professional | | $218.78 | $426.58 | $3,467.37 |
- 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
- $309.03 / $446.68 / $1,047.13
| Professional | | $309.03 | $446.68 | $1,047.13 |