- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,691.53 / $4,265.80 / $8,709.64
| Facility | | $2,691.53 | $4,265.80 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $794.33 / $3,311.31 / $6,456.54
| Professional | | $794.33 | $3,311.31 | $6,456.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,778.28 / $6,309.57 / $33,884.42
| Facility | | $1,778.28 | $6,309.57 | $33,884.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $870.96 / $3,162.28 / $12,589.25
| Professional | | $870.96 | $3,162.28 | $12,589.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $933.25 / $933.25 / $2,187.76
| Facility | | $933.25 | $933.25 | $2,187.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $891.25 / $2,630.27 / $10,232.93
| Professional | | $891.25 | $2,630.27 | $10,232.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $724.44 / $1,584.89 / $7,762.47
| Facility | | $724.44 | $1,584.89 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,897.79 / $6,025.60 / $8,317.64
| Professional | | $4,897.79 | $6,025.60 | $8,317.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,511.89 / $6,165.95 / $13,182.57
| Facility | | $2,511.89 | $6,165.95 | $13,182.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $870.96 / $3,388.44 / $10,471.29
| Professional | | $870.96 | $3,388.44 | $10,471.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,862.09 / $6,309.57 / $33,884.42
| Facility | | $1,862.09 | $6,309.57 | $33,884.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $870.96 / $3,162.28 / $12,589.25
| Professional | | $870.96 | $3,162.28 | $12,589.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,511.89 / $6,309.57 / $13,803.84
| Facility | | $2,511.89 | $6,309.57 | $13,803.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $891.25 / $2,630.27 / $10,232.93
| Professional | | $891.25 | $2,630.27 | $10,232.93 |