- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,949.84 / $3,630.78 / $5,623.41
| Facility | | $1,949.84 | $3,630.78 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $912.01 / $1,148.15 / $2,951.21
| Professional | | $912.01 | $1,148.15 | $2,951.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $4,677.35 / $16,218.10
| Facility | | $56.23 | $4,677.35 | $16,218.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $933.25 / $1,548.82 / $11,481.54
| Professional | | $933.25 | $1,548.82 | $11,481.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,023.29 / $1,548.82 / $2,754.23
| Professional | | $1,023.29 | $1,548.82 | $2,754.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $302.00 / $1,621.81 / $8,511.38
| Facility | | $302.00 | $1,621.81 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,096.48 / $1,348.96 / $1,905.46
| Professional | | $1,096.48 | $1,348.96 | $1,905.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,570.40 / $6,918.31 / $15,488.17
| Facility | | $2,570.40 | $6,918.31 | $15,488.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,023.29 / $1,819.70 / $2,691.53
| Professional | | $1,023.29 | $1,819.70 | $2,691.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $4,677.35 / $16,218.10
| Facility | | $56.23 | $4,677.35 | $16,218.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $933.25 / $1,548.82 / $11,481.54
| Professional | | $933.25 | $1,548.82 | $11,481.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,570.40 / $7,244.36 / $16,595.87
| Facility | | $2,570.40 | $7,244.36 | $16,595.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,071.52 / $1,548.82 / $3,019.95
| Professional | | $1,071.52 | $1,548.82 | $3,019.95 |