- 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
- $676.08 / $954.99 / $1,905.46
| Professional | | $676.08 | $954.99 | $1,905.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,949.84 / $6,165.95 / $45,708.82
| Facility | | $1,949.84 | $6,165.95 | $45,708.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $707.95 / $1,122.02 / $6,165.95
| Professional | | $707.95 | $1,122.02 | $6,165.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $691.83 / $2,187.76 / $2,187.76
| Professional | | $691.83 | $2,187.76 | $2,187.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $724.44 / $1,445.44 / $2,454.71
| Professional | | $724.44 | $1,445.44 | $2,454.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.44 / $1,737.80 / $7,079.46
| Facility | | $575.44 | $1,737.80 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $870.96 / $1,096.48 / $1,513.56
| Professional | | $870.96 | $1,096.48 | $1,513.56 |
- 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
- $776.25 / $1,380.38 / $2,511.89
| Professional | | $776.25 | $1,380.38 | $2,511.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,089.30 / $6,309.57 / $45,708.82
| Facility | | $2,089.30 | $6,309.57 | $45,708.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $707.95 / $1,122.02 / $6,165.95
| Professional | | $707.95 | $1,122.02 | $6,165.95 |
- 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
- $758.58 / $1,096.48 / $2,398.83
| Professional | | $758.58 | $1,096.48 | $2,398.83 |