- 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
- $575.44 / $707.95 / $1,737.80
| Professional | | $575.44 | $707.95 | $1,737.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,479.11 / $5,623.41 / $28,840.32
| Facility | | $1,479.11 | $5,623.41 | $28,840.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $588.84 / $1,047.13 / $5,495.41
| Professional | | $588.84 | $1,047.13 | $5,495.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $645.65 / $1,000.00 / $1,778.28
| Professional | | $645.65 | $1,000.00 | $1,778.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $501.19 / $1,348.96 / $7,079.46
| Facility | | $501.19 | $1,348.96 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $676.08 / $851.14 / $1,174.90
| Professional | | $676.08 | $851.14 | $1,174.90 |
- 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
- $645.65 / $1,174.90 / $1,862.09
| Professional | | $645.65 | $1,174.90 | $1,862.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,513.56 / $5,623.41 / $28,840.32
| Facility | | $1,513.56 | $5,623.41 | $28,840.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $588.84 / $1,047.13 / $5,495.41
| Professional | | $588.84 | $1,047.13 | $5,495.41 |
- 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
- $676.08 / $1,047.13 / $1,905.46
| Professional | | $676.08 | $1,047.13 | $1,905.46 |