- 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
- $707.95 / $851.14 / $2,511.89
| Professional | | $707.95 | $851.14 | $2,511.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,862.09 / $6,309.57 / $28,840.32
| Facility | | $1,862.09 | $6,309.57 | $28,840.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $616.60 / $1,174.90 / $8,912.51
| Professional | | $616.60 | $1,174.90 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $812.83 / $1,479.11 / $2,818.38
| Professional | | $812.83 | $1,479.11 | $2,818.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $501.19 / $1,548.82 / $7,079.46
| Facility | | $501.19 | $1,548.82 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $426.58 / $831.76 / $1,230.27
| Professional | | $426.58 | $831.76 | $1,230.27 |
- 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
- $741.31 / $1,380.38 / $2,238.72
| Professional | | $741.31 | $1,380.38 | $2,238.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,862.09 / $6,456.54 / $28,840.32
| Facility | | $1,862.09 | $6,456.54 | $28,840.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $616.60 / $1,148.15 / $8,912.51
| Professional | | $616.60 | $1,148.15 | $8,912.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,041.74 / $5,248.07 / $12,022.64
| Facility | | $2,041.74 | $5,248.07 | $12,022.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $851.14 / $1,230.27 / $2,884.03
| Professional | | $851.14 | $1,230.27 | $2,884.03 |