- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,023.29 / $3,630.78 / $6,456.54
| Facility | | $1,023.29 | $3,630.78 | $6,456.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $602.56 / $758.58 / $1,949.84
| Professional | | $602.56 | $758.58 | $1,949.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $4,677.35 / $16,218.10
| Facility | | $56.23 | $4,677.35 | $16,218.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $645.65 / $1,096.48 / $5,248.07
| Professional | | $645.65 | $1,096.48 | $5,248.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $870.96 / $1,479.11 / $1,949.84
| Professional | | $870.96 | $1,479.11 | $1,949.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $691.83 / $1,096.48 / $2,041.74
| Professional | | $691.83 | $1,096.48 | $2,041.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $501.19 / $1,479.11 / $7,079.46
| Facility | | $501.19 | $1,479.11 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $758.58 / $954.99 / $1,318.26
| Professional | | $758.58 | $954.99 | $1,318.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,570.40 / $6,918.31 / $15,488.17
| Facility | | $2,570.40 | $6,918.31 | $15,488.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $691.83 / $1,230.27 / $1,862.09
| Professional | | $691.83 | $1,230.27 | $1,862.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $4,677.35 / $16,218.10
| Facility | | $56.23 | $4,677.35 | $16,218.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $645.65 / $1,096.48 / $5,248.07
| Professional | | $645.65 | $1,096.48 | $5,248.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,570.40 / $6,165.95 / $14,125.38
| Facility | | $2,570.40 | $6,165.95 | $14,125.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $707.95 / $1,047.13 / $2,041.74
| Professional | | $707.95 | $1,047.13 | $2,041.74 |