- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,621.81 / $4,466.84 / $5,495.41
| Facility | | $1,621.81 | $4,466.84 | $5,495.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $457.09 / $630.96 / $1,096.48
| Professional | | $457.09 | $630.96 | $1,096.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,445.44 / $5,370.32 / $13,489.63
| Facility | | $1,445.44 | $5,370.32 | $13,489.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $812.83 / $954.99 / $977.24
| Professional | | $812.83 | $954.99 | $977.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $588.84 / $776.25 / $933.25
| Professional | | $588.84 | $776.25 | $933.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $537.03 / $1,000.00 / $3,162.28
| Facility | | $537.03 | $1,000.00 | $3,162.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $501.19 / $851.14 / $977.24
| Professional | | $501.19 | $851.14 | $977.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $32.36 / $33.11
| Professional | | $32.36 | $32.36 | $33.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,511.38 / $11,748.98 / $16,218.10
| Facility | | $8,511.38 | $11,748.98 | $16,218.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $660.69 / $794.33 / $933.25
| Professional | | $660.69 | $794.33 | $933.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $416.87 / $851.14 / $12,302.69
| Professional | | $416.87 | $851.14 | $12,302.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,332.54 / $16,982.44 / $18,197.01
| Facility | | $9,332.54 | $16,982.44 | $18,197.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $489.78 / $676.08 / $1,000.00
| Professional | | $489.78 | $676.08 | $1,000.00 |