- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,653.00 / $5,463.36 / $13,841.56
| Facility | | $1,653.00 | $5,463.36 | $13,841.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $505.37 / $541.90 / $2,844.46
| Professional | | $505.37 | $541.90 | $2,844.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,350.61 / $4,406.97 / $8,524.51
| Facility | | $3,350.61 | $4,406.97 | $8,524.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $526.58 / $897.59 / $1,196.78
| Professional | | $526.58 | $897.59 | $1,196.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,257.44 / $1,257.44 / $1,257.44
| Facility | | $1,257.44 | $1,257.44 | $1,257.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $828.00 / $1,298.36 / $1,701.36
| Professional | | $828.00 | $1,298.36 | $1,701.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $541.90 / $975.42 / $3,726.00
| Facility | | $541.90 | $975.42 | $3,726.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $671.54 / $1,110.63 / $1,527.04
| Professional | | $671.54 | $1,110.63 | $1,527.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $953.00 / $1,298.36 / $1,719.96
| Facility | | $953.00 | $1,298.36 | $1,719.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $920.00 / $1,143.08 / $1,642.61
| Professional | | $920.00 | $1,143.08 | $1,642.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $602.64 / $1,050.76 / $1,196.68
| Professional | | $602.64 | $1,050.76 | $1,196.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,044.00 / $3,726.00 / $7,934.00
| Facility | | $3,044.00 | $3,726.00 | $7,934.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $671.54 / $1,067.11 / $1,446.40
| Professional | | $671.54 | $1,067.11 | $1,446.40 |