- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,884.03 / $4,466.84 / $5,495.41
| Facility | | $2,884.03 | $4,466.84 | $5,495.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $371.54 / $1,513.56 / $4,466.84
| Professional | | $371.54 | $1,513.56 | $4,466.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,258.93 / $3,630.78 / $8,317.64
| Facility | | $1,258.93 | $3,630.78 | $8,317.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $588.84 / $2,238.72 / $2,691.53
| Professional | | $588.84 | $2,238.72 | $2,691.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $446.68 / $676.08 / $2,951.21
| Professional | | $446.68 | $676.08 | $2,951.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $436.52 / $1,548.82 / $4,570.88
| Facility | | $436.52 | $1,548.82 | $4,570.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $524.81 / $2,238.72 / $3,162.28
| Professional | | $524.81 | $2,238.72 | $3,162.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $32.36 / $33.11
| Professional | | $32.36 | $32.36 | $33.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,754.40 / $7,244.36 / $10,471.29
| Facility | | $5,754.40 | $7,244.36 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $616.60 / $707.95 / $3,162.28
| Professional | | $616.60 | $707.95 | $3,162.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $602.56 / $1,445.44 / $6,025.60
| Professional | | $602.56 | $1,445.44 | $6,025.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,332.54 / $17,782.79 / $19,054.61
| Facility | | $9,332.54 | $17,782.79 | $19,054.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $338.84 / $1,148.15 / $2,238.72
| Professional | | $338.84 | $1,148.15 | $2,238.72 |