- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,778.28 / $3,090.30 / $5,128.61
| Facility | | $1,778.28 | $3,090.30 | $5,128.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $660.69 / $831.76 / $2,041.74
| Professional | | $660.69 | $831.76 | $2,041.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,318.26 / $4,897.79 / $45,708.82
| Facility | | $1,318.26 | $4,897.79 | $45,708.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $676.08 / $1,122.02 / $5,370.32
| Professional | | $676.08 | $1,122.02 | $5,370.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $724.44 / $1,148.15 / $2,089.30
| Professional | | $724.44 | $1,148.15 | $2,089.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.44 / $1,513.56 / $7,079.46
| Facility | | $575.44 | $1,513.56 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $776.25 / $977.24 / $1,318.26
| Professional | | $776.25 | $977.24 | $1,318.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,995.26 / $4,265.80 / $9,772.37
| Facility | | $1,995.26 | $4,265.80 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $707.95 / $1,318.26 / $2,137.96
| Professional | | $707.95 | $1,318.26 | $2,137.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,659.59 / $4,897.79 / $45,708.82
| Facility | | $1,659.59 | $4,897.79 | $45,708.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $676.08 / $1,122.02 / $5,370.32
| Professional | | $676.08 | $1,122.02 | $5,370.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,862.09 / $4,265.80 / $12,302.69
| Facility | | $1,862.09 | $4,265.80 | $12,302.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $758.58 / $1,122.02 / $2,187.76
| Professional | | $758.58 | $1,122.02 | $2,187.76 |