- 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
- $741.31 / $870.96 / $2,290.87
| Professional | | $741.31 | $870.96 | $2,290.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,862.09 / $7,079.46 / $33,884.42
| Facility | | $1,862.09 | $7,079.46 | $33,884.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $758.58 / $1,258.93 / $6,025.60
| Professional | | $758.58 | $1,258.93 | $6,025.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $977.24 / $1,659.59 / $2,238.72
| Professional | | $977.24 | $1,659.59 | $2,238.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $812.83 / $1,258.93 / $2,290.87
| Professional | | $812.83 | $1,258.93 | $2,290.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $707.95 / $1,659.59 / $7,079.46
| Facility | | $707.95 | $1,659.59 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $851.14 / $1,071.52 / $1,479.11
| Professional | | $851.14 | $1,071.52 | $1,479.11 |
- 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
- $776.25 / $1,479.11 / $2,344.23
| Professional | | $776.25 | $1,479.11 | $2,344.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,949.84 / $7,079.46 / $33,884.42
| Facility | | $1,949.84 | $7,079.46 | $33,884.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $758.58 / $1,258.93 / $6,025.60
| Professional | | $758.58 | $1,258.93 | $6,025.60 |
- 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
- $831.76 / $1,258.93 / $2,398.83
| Professional | | $831.76 | $1,258.93 | $2,398.83 |