- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,570.40 / $3,715.35 / $6,456.54
| Facility | | $2,570.40 | $3,715.35 | $6,456.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $724.44 / $851.14 / $2,187.76
| Professional | | $724.44 | $851.14 | $2,187.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,819.70 / $6,760.83 / $42,657.95
| Facility | | $1,819.70 | $6,760.83 | $42,657.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $758.58 / $1,202.26 / $5,888.44
| Professional | | $758.58 | $1,202.26 | $5,888.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $794.33 / $1,258.93 / $2,290.87
| Professional | | $794.33 | $1,258.93 | $2,290.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $741.31 / $1,621.81 / $7,079.46
| Facility | | $741.31 | $1,621.81 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $831.76 / $1,047.13 / $1,445.44
| Professional | | $831.76 | $1,047.13 | $1,445.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,691.53 / $6,918.31 / $20,417.38
| Facility | | $2,691.53 | $6,918.31 | $20,417.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $776.25 / $1,445.44 / $2,344.23
| Professional | | $776.25 | $1,445.44 | $2,344.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,949.84 / $6,760.83 / $42,657.95
| Facility | | $1,949.84 | $6,760.83 | $42,657.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $758.58 / $1,202.26 / $5,888.44
| Professional | | $758.58 | $1,202.26 | $5,888.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,691.53 / $7,244.36 / $33,884.42
| Facility | | $2,691.53 | $7,244.36 | $33,884.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $812.83 / $1,202.26 / $2,344.23
| Professional | | $812.83 | $1,202.26 | $2,344.23 |