- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,778.28 / $3,311.31 / $5,128.61
| Facility | | $1,778.28 | $3,311.31 | $5,128.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $912.01 / $1,071.52 / $2,511.89
| Professional | | $912.01 | $1,071.52 | $2,511.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,659.59 / $5,623.41 / $45,708.82
| Facility | | $1,659.59 | $5,623.41 | $45,708.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $851.14 / $1,445.44 / $7,413.10
| Professional | | $851.14 | $1,445.44 | $7,413.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $954.99 / $1,445.44 / $2,754.23
| Professional | | $954.99 | $1,445.44 | $2,754.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.44 / $1,949.84 / $7,079.46
| Facility | | $575.44 | $1,949.84 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,023.29 / $1,258.93 / $1,737.80
| Professional | | $1,023.29 | $1,258.93 | $1,737.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,137.96 / $5,248.07 / $11,220.18
| Facility | | $2,137.96 | $5,248.07 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $933.25 / $1,737.80 / $2,818.38
| Professional | | $933.25 | $1,737.80 | $2,818.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,137.96 / $5,623.41 / $45,708.82
| Facility | | $2,137.96 | $5,623.41 | $45,708.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $851.14 / $1,445.44 / $7,413.10
| Professional | | $851.14 | $1,445.44 | $7,413.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,041.74 / $5,248.07 / $10,715.19
| Facility | | $2,041.74 | $5,248.07 | $10,715.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $933.25 / $1,445.44 / $2,818.38
| Professional | | $933.25 | $1,445.44 | $2,818.38 |