- 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
- $691.83 / $812.83 / $2,089.30
| Professional | | $691.83 | $812.83 | $2,089.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,659.59 / $5,623.41 / $28,840.32
| Facility | | $1,659.59 | $5,623.41 | $28,840.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $707.95 / $1,174.90 / $7,244.36
| Professional | | $707.95 | $1,174.90 | $7,244.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $758.58 / $1,174.90 / $2,137.96
| Professional | | $758.58 | $1,174.90 | $2,137.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $501.19 / $1,584.89 / $7,079.46
| Facility | | $501.19 | $1,584.89 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $812.83 / $1,023.29 / $1,412.54
| Professional | | $812.83 | $1,023.29 | $1,412.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,137.96 / $5,248.07 / $11,220.18
| Facility | | $2,137.96 | $5,248.07 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $741.31 / $1,380.38 / $2,238.72
| Professional | | $741.31 | $1,380.38 | $2,238.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,737.80 / $5,623.41 / $28,840.32
| Facility | | $1,737.80 | $5,623.41 | $28,840.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $707.95 / $1,174.90 / $7,244.36
| Professional | | $707.95 | $1,174.90 | $7,244.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,041.74 / $5,248.07 / $13,182.57
| Facility | | $2,041.74 | $5,248.07 | $13,182.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $794.33 / $1,174.90 / $2,290.87
| Professional | | $794.33 | $1,174.90 | $2,290.87 |