- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,884.03 / $4,466.84 / $5,495.41
| Facility | | $2,884.03 | $4,466.84 | $5,495.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $575.44 / $851.14 / $1,288.25
| Professional | | $575.44 | $851.14 | $1,288.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,548.82 / $3,388.44 / $6,025.60
| Facility | | $1,548.82 | $3,388.44 | $6,025.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $912.01 / $1,071.52 / $1,174.90
| Professional | | $912.01 | $1,071.52 | $1,174.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $446.68 / $707.95 / $1,000.00
| Professional | | $446.68 | $707.95 | $1,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $457.09 / $1,000.00 / $4,466.84
| Facility | | $457.09 | $1,000.00 | $4,466.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $489.78 / $851.14 / $1,071.52
| Professional | | $489.78 | $851.14 | $1,071.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $32.36 / $33.11
| Professional | | $32.36 | $32.36 | $33.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,073.80 / $5,248.07 / $7,585.78
| Facility | | $4,073.80 | $5,248.07 | $7,585.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $758.58 / $1,071.52 / $1,819.70
| Professional | | $758.58 | $1,071.52 | $1,819.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $457.09 / $933.25 / $5,623.41
| Professional | | $457.09 | $933.25 | $5,623.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $501.19 / $3,467.37 / $7,762.47
| Facility | | $501.19 | $3,467.37 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $549.54 / $758.58 / $1,096.48
| Professional | | $549.54 | $758.58 | $1,096.48 |