- 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
- $851.14 / $1,047.13 / $3,090.30
| Professional | | $851.14 | $1,047.13 | $3,090.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,137.96 / $4,570.88 / $45,708.82
| Facility | | $2,137.96 | $4,570.88 | $45,708.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $794.33 / $1,479.11 / $8,511.38
| Professional | | $794.33 | $1,479.11 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $954.99 / $1,737.80 / $3,235.94
| Professional | | $954.99 | $1,737.80 | $3,235.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.44 / $1,778.28 / $7,079.46
| Facility | | $575.44 | $1,778.28 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $501.19 / $977.24 / $1,445.44
| Professional | | $501.19 | $977.24 | $1,445.44 |
- 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
- $870.96 / $1,621.81 / $2,630.27
| Professional | | $870.96 | $1,621.81 | $2,630.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,137.96 / $5,011.87 / $45,708.82
| Facility | | $2,137.96 | $5,011.87 | $45,708.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $794.33 / $1,445.44 / $8,511.38
| Professional | | $794.33 | $1,445.44 | $8,511.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,041.74 / $5,248.07 / $9,332.54
| Facility | | $2,041.74 | $5,248.07 | $9,332.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,023.29 / $1,584.89 / $3,090.30
| Professional | | $1,023.29 | $1,584.89 | $3,090.30 |