- 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
- $741.31 / $1,174.90 / $2,818.38
| Professional | | $741.31 | $1,174.90 | $2,818.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,041.74 / $5,128.61 / $45,708.82
| Facility | | $2,041.74 | $5,128.61 | $45,708.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $851.14 / $1,513.56 / $7,585.78
| Professional | | $851.14 | $1,513.56 | $7,585.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,995.26 / $2,238.72 / $2,951.21
| Professional | | $1,995.26 | $2,238.72 | $2,951.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $630.96 / $1,862.09 / $3,715.35
| Professional | | $630.96 | $1,862.09 | $3,715.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.44 / $1,995.26 / $7,079.46
| Facility | | $575.44 | $1,995.26 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,258.93 / $1,584.89 / $2,187.76
| Professional | | $1,258.93 | $1,584.89 | $2,187.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,995.26 / $4,265.80 / $9,772.37
| Facility | | $1,995.26 | $4,265.80 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,096.48 / $2,041.74 / $3,311.31
| Professional | | $1,096.48 | $2,041.74 | $3,311.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,511.89 / $5,370.32 / $45,708.82
| Facility | | $2,511.89 | $5,370.32 | $45,708.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $851.14 / $1,479.11 / $7,585.78
| Professional | | $851.14 | $1,479.11 | $7,585.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,862.09 / $4,265.80 / $11,220.18
| Facility | | $1,862.09 | $4,265.80 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,023.29 / $1,584.89 / $3,467.37
| Professional | | $1,023.29 | $1,584.89 | $3,467.37 |