- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,778.28 / $3,311.31 / $5,128.61
| Facility | | $1,778.28 | $3,311.31 | $5,128.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $707.95 / $831.76 / $2,137.96
| Professional | | $707.95 | $831.76 | $2,137.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $3,981.07 / $16,595.87
| Facility | | $56.23 | $3,981.07 | $16,595.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $691.83 / $1,202.26 / $5,754.40
| Professional | | $691.83 | $1,202.26 | $5,754.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $933.25 / $1,621.81 / $2,137.96
| Professional | | $933.25 | $1,621.81 | $2,137.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $758.58 / $1,230.27 / $2,238.72
| Professional | | $758.58 | $1,230.27 | $2,238.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $302.00 / $1,258.93 / $8,511.38
| Facility | | $302.00 | $1,258.93 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $831.76 / $1,047.13 / $1,412.54
| Professional | | $831.76 | $1,047.13 | $1,412.54 |
- 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
- $758.58 / $1,412.54 / $2,290.87
| Professional | | $758.58 | $1,412.54 | $2,290.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $3,981.07 / $16,595.87
| Facility | | $56.23 | $3,981.07 | $16,595.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $691.83 / $1,202.26 / $5,754.40
| Professional | | $691.83 | $1,202.26 | $5,754.40 |
- 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
- $776.25 / $1,174.90 / $2,290.87
| Professional | | $776.25 | $1,174.90 | $2,290.87 |