- 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
- $794.33 / $954.99 / $2,290.87
| Professional | | $794.33 | $954.99 | $2,290.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $3,981.07 / $16,218.10
| Facility | | $56.23 | $3,981.07 | $16,218.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $831.76 / $1,412.54 / $7,079.46
| Professional | | $831.76 | $1,412.54 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $851.14 / $1,348.96 / $2,454.71
| Professional | | $851.14 | $1,348.96 | $2,454.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $302.00 / $1,348.96 / $8,511.38
| Facility | | $302.00 | $1,348.96 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $891.25 / $1,122.02 / $1,548.82
| Professional | | $891.25 | $1,122.02 | $1,548.82 |
- 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
- $812.83 / $1,479.11 / $2,187.76
| Professional | | $812.83 | $1,479.11 | $2,187.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $3,981.07 / $16,218.10
| Facility | | $56.23 | $3,981.07 | $16,218.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $831.76 / $1,412.54 / $7,079.46
| Professional | | $831.76 | $1,412.54 | $7,079.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,511.89 / $6,165.95 / $13,803.84
| Facility | | $2,511.89 | $6,165.95 | $13,803.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $912.01 / $1,412.54 / $2,454.71
| Professional | | $912.01 | $1,412.54 | $2,454.71 |