- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,653.00 / $5,463.36 / $13,841.56
| Facility | | $1,653.00 | $5,463.36 | $13,841.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $581.49 / $581.49 / $3,325.44
| Professional | | $581.49 | $581.49 | $3,325.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,183.05 / $10,762.95 / $20,819.02
| Facility | | $8,183.05 | $10,762.95 | $20,819.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $563.09 / $959.80 / $1,279.74
| Professional | | $563.09 | $959.80 | $1,279.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,266.26 / $5,266.26 / $5,266.26
| Facility | | $5,266.26 | $5,266.26 | $5,266.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $971.00 / $1,399.88 / $1,871.33
| Professional | | $971.00 | $1,399.88 | $1,871.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $581.49 / $1,017.61 / $7,934.00
| Facility | | $581.49 | $1,017.61 | $7,934.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $766.66 / $1,267.94 / $1,741.29
| Professional | | $766.66 | $1,267.94 | $1,741.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $953.00 / $1,522.00 / $6,616.19
| Facility | | $953.00 | $1,522.00 | $6,616.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,059.55 / $1,382.87 / $1,871.33
| Professional | | $1,059.55 | $1,382.87 | $1,871.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $636.39 / $1,109.59 / $1,277.86
| Professional | | $636.39 | $1,109.59 | $1,277.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,217.00 / $6,451.00 / $7,934.00
| Facility | | $4,217.00 | $6,451.00 | $7,934.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $766.66 / $1,267.94 / $1,651.27
| Professional | | $766.66 | $1,267.94 | $1,651.27 |