- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $831.76 / $4,677.35 / $11,748.98
| Facility | | $831.76 | $4,677.35 | $11,748.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $676.08 / $1,071.52 / $1,949.84
| Professional | | $676.08 | $1,071.52 | $1,949.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $478.63 / $776.25 / $1,348.96
| Professional | | $478.63 | $776.25 | $1,348.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,238.72 / $4,897.79 / $11,481.54
| Facility | | $2,238.72 | $4,897.79 | $11,481.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $776.25 / $977.24 / $1,479.11
| Professional | | $776.25 | $977.24 | $1,479.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $537.03 / $588.84 / $1,096.48
| Professional | | $537.03 | $588.84 | $1,096.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $426.58 / $1,047.13 / $1,737.80
| Professional | | $426.58 | $1,047.13 | $1,737.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $831.76 / $2,884.03 / $26,302.68
| Facility | | $831.76 | $2,884.03 | $26,302.68 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $1,479.11 / $10,964.78 / $10,964.78
| Facility | 52 | $1,479.11 | $10,964.78 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $758.58 / $1,258.93 / $5,370.32
| Professional | | $758.58 | $1,258.93 | $5,370.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,454.71 / $3,715.35 / $6,165.95
| Facility | | $2,454.71 | $3,715.35 | $6,165.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $707.95 / $1,023.29 / $1,659.59
| Professional | | $707.95 | $1,023.29 | $1,659.59 |