- 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
- $741.31 / $870.96 / $2,187.76
| Professional | | $741.31 | $870.96 | $2,187.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,862.09 / $5,888.44 / $34,673.69
| Facility | | $1,862.09 | $5,888.44 | $34,673.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $724.44 / $1,230.27 / $6,025.60
| Professional | | $724.44 | $1,230.27 | $6,025.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $794.33 / $1,230.27 / $2,290.87
| Professional | | $794.33 | $1,230.27 | $2,290.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $776.25 / $1,659.59 / $8,511.38
| Facility | | $776.25 | $1,659.59 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $851.14 / $1,071.52 / $1,479.11
| Professional | | $851.14 | $1,071.52 | $1,479.11 |
- 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
- $794.33 / $1,479.11 / $2,398.83
| Professional | | $794.33 | $1,479.11 | $2,398.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,949.84 / $5,888.44 / $34,673.69
| Facility | | $1,949.84 | $5,888.44 | $34,673.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $724.44 / $1,230.27 / $6,025.60
| Professional | | $724.44 | $1,230.27 | $6,025.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,511.89 / $6,309.57 / $17,378.01
| Facility | | $2,511.89 | $6,309.57 | $17,378.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $794.33 / $1,230.27 / $2,398.83
| Professional | | $794.33 | $1,230.27 | $2,398.83 |