- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,513.56 / $2,884.03 / $5,128.61
| Facility | | $1,513.56 | $2,884.03 | $5,128.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $676.08 / $794.33 / $1,949.84
| Professional | | $676.08 | $794.33 | $1,949.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,698.24 / $7,413.10 / $28,840.32
| Facility | | $1,698.24 | $7,413.10 | $28,840.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $630.96 / $1,096.48 / $5,495.41
| Professional | | $630.96 | $1,096.48 | $5,495.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $575.44 / $1,122.02 / $2,137.96
| Professional | | $575.44 | $1,122.02 | $2,137.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $501.19 / $1,584.89 / $7,079.46
| Facility | | $501.19 | $1,584.89 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $794.33 / $1,000.00 / $1,380.38
| Professional | | $794.33 | $1,000.00 | $1,380.38 |
- 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
- $741.31 / $1,380.38 / $2,187.76
| Professional | | $741.31 | $1,380.38 | $2,187.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,819.70 / $7,413.10 / $28,840.32
| Facility | | $1,819.70 | $7,413.10 | $28,840.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $630.96 / $1,096.48 / $5,495.41
| Professional | | $630.96 | $1,096.48 | $5,495.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,570.40 / $7,244.36 / $16,595.87
| Facility | | $2,570.40 | $7,244.36 | $16,595.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $676.08 / $1,096.48 / $2,238.72
| Professional | | $676.08 | $1,096.48 | $2,238.72 |