- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,570.40 / $3,715.35 / $6,918.31
| Facility | | $2,570.40 | $3,715.35 | $6,918.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $933.25 / $1,148.15 / $4,168.69
| Professional | | $933.25 | $1,148.15 | $4,168.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $3,801.89 / $8,128.31
| Facility | | $56.23 | $3,801.89 | $8,128.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $851.14 / $1,548.82 / $8,912.51
| Professional | | $851.14 | $1,548.82 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,047.13 / $1,862.09 / $3,548.13
| Professional | | $1,047.13 | $1,862.09 | $3,548.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $707.95 / $1,949.84 / $7,079.46
| Facility | | $707.95 | $1,949.84 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $537.03 / $1,047.13 / $1,548.82
| Professional | | $537.03 | $1,047.13 | $1,548.82 |
- 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
- $933.25 / $1,778.28 / $2,818.38
| Professional | | $933.25 | $1,778.28 | $2,818.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,786.30 / $4,786.30 / $4,786.30
| Facility | | $4,786.30 | $4,786.30 | $4,786.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $3,801.89 / $8,128.31
| Facility | | $56.23 | $3,801.89 | $8,128.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $851.14 / $1,548.82 / $8,912.51
| Professional | | $851.14 | $1,548.82 | $8,912.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,041.74 / $5,248.07 / $11,220.18
| Facility | | $2,041.74 | $5,248.07 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,096.48 / $1,698.24 / $3,388.44
| Professional | | $1,096.48 | $1,698.24 | $3,388.44 |