- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,949.84 / $3,715.35 / $12,302.69
| Facility | | $1,949.84 | $3,715.35 | $12,302.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $707.95 / $977.24 / $2,691.53
| Professional | | $707.95 | $977.24 | $2,691.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,737.80 / $7,079.46 / $33,884.42
| Facility | | $1,737.80 | $7,079.46 | $33,884.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $724.44 / $1,202.26 / $5,623.41
| Professional | | $724.44 | $1,202.26 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $912.01 / $1,584.89 / $2,089.30
| Professional | | $912.01 | $1,584.89 | $2,089.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $758.58 / $1,202.26 / $2,187.76
| Professional | | $758.58 | $1,202.26 | $2,187.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $707.95 / $1,548.82 / $7,079.46
| Facility | | $707.95 | $1,548.82 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $794.33 / $1,000.00 / $1,380.38
| Professional | | $794.33 | $1,000.00 | $1,380.38 |
- 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
- $741.31 / $1,348.96 / $2,187.76
| Professional | | $741.31 | $1,348.96 | $2,187.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,079.46 / $7,079.46 / $14,454.40
| Facility | | $7,079.46 | $7,079.46 | $14,454.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.78 / $173.78 / $1,737.80
| Professional | | $173.78 | $173.78 | $1,737.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,819.70 / $7,079.46 / $33,884.42
| Facility | | $1,819.70 | $7,079.46 | $33,884.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $724.44 / $1,202.26 / $5,623.41
| Professional | | $724.44 | $1,202.26 | $5,623.41 |
- 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
- $794.33 / $1,202.26 / $2,187.76
| Professional | | $794.33 | $1,202.26 | $2,187.76 |