- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,511.89 / $4,466.84 / $8,511.38
| Facility | | $2,511.89 | $4,466.84 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $616.60 / $831.76 / $1,698.24
| Professional | | $616.60 | $831.76 | $1,698.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $707.95 / $794.33 / $912.01
| Professional | | $707.95 | $794.33 | $912.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $676.08 / $1,819.70 / $4,168.69
| Facility | | $676.08 | $1,819.70 | $4,168.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $891.25 / $1,047.13 / $1,659.59
| Professional | | $891.25 | $1,047.13 | $1,659.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $537.03 / $575.44 / $1,288.25
| Professional | | $537.03 | $575.44 | $1,288.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $588.84 / $588.84 / $2,344.23
| Facility | | $588.84 | $588.84 | $2,344.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $446.68 / $1,174.90 / $2,630.27
| Professional | | $446.68 | $1,174.90 | $2,630.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $54.95 / $1,737.80 / $11,220.18
| Facility | | $54.95 | $1,737.80 | $11,220.18 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $1,122.02 / $7,943.28 / $7,943.28
| Facility | 54 | $1,122.02 | $7,943.28 | $7,943.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $812.83 / $1,230.27 / $4,677.35
| Professional | | $812.83 | $1,230.27 | $4,677.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,454.71 / $3,235.94 / $6,918.31
| Facility | | $2,454.71 | $3,235.94 | $6,918.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $812.83 / $1,071.52 / $1,659.59
| Professional | | $812.83 | $1,071.52 | $1,659.59 |