- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,513.56 / $2,884.03 / $5,128.61
| Facility | | $1,513.56 | $2,884.03 | $5,128.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $316.23 / $416.87 / $977.24
| Professional | | $316.23 | $416.87 | $977.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $794.33 / $3,630.78 / $28,840.32
| Facility | | $794.33 | $3,630.78 | $28,840.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $316.23 / $524.81 / $3,235.94
| Professional | | $316.23 | $524.81 | $3,235.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.74 / $562.34 / $912.01
| Professional | | $346.74 | $562.34 | $912.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $309.03 / $660.69 / $7,079.46
| Facility | | $309.03 | $660.69 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.74 / $426.58 / $602.56
| Professional | | $346.74 | $426.58 | $602.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,698.24 / $3,630.78 / $8,511.38
| Facility | | $1,698.24 | $3,630.78 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $323.59 / $588.84 / $954.99
| Professional | | $323.59 | $588.84 | $954.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $794.33 / $3,630.78 / $28,840.32
| Facility | | $794.33 | $3,630.78 | $28,840.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $316.23 / $524.81 / $3,235.94
| Professional | | $316.23 | $524.81 | $3,235.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,584.89 / $3,630.78 / $8,511.38
| Facility | | $1,584.89 | $3,630.78 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $338.84 / $524.81 / $1,000.00
| Professional | | $338.84 | $524.81 | $1,000.00 |