- 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
- $562.34 / $676.08 / $1,995.26
| Professional | | $562.34 | $676.08 | $1,995.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,479.11 / $5,128.61 / $45,708.82
| Facility | | $1,479.11 | $5,128.61 | $45,708.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $489.78 / $933.25 / $5,370.32
| Professional | | $489.78 | $933.25 | $5,370.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $616.60 / $1,174.90 / $2,238.72
| Professional | | $616.60 | $1,174.90 | $2,238.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.44 / $1,230.27 / $7,079.46
| Facility | | $575.44 | $1,230.27 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.74 / $676.08 / $1,000.00
| Professional | | $346.74 | $676.08 | $1,000.00 |
- 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
- $588.84 / $1,122.02 / $1,819.70
| Professional | | $588.84 | $1,122.02 | $1,819.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,479.11 / $5,370.32 / $45,708.82
| Facility | | $1,479.11 | $5,370.32 | $45,708.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $489.78 / $933.25 / $5,370.32
| Professional | | $489.78 | $933.25 | $5,370.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,862.09 / $4,265.80 / $11,220.18
| Facility | | $1,862.09 | $4,265.80 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $676.08 / $1,000.00 / $2,290.87
| Professional | | $676.08 | $1,000.00 | $2,290.87 |