- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,949.84 / $3,630.78 / $5,623.41
| Facility | | $1,949.84 | $3,630.78 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $602.56 / $776.25 / $1,621.81
| Professional | | $602.56 | $776.25 | $1,621.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,548.82 / $5,248.07 / $11,220.18
| Facility | | $1,548.82 | $5,248.07 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $562.34 / $912.01 / $5,623.41
| Professional | | $562.34 | $912.01 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $851.14 / $2,187.76 / $2,187.76
| Professional | | $851.14 | $2,187.76 | $2,187.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,089.30 / $2,089.30 / $2,089.30
| Facility | | $2,089.30 | $2,089.30 | $2,089.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $562.34 / $1,174.90 / $2,137.96
| Professional | | $562.34 | $1,174.90 | $2,137.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.44 / $1,230.27 / $7,079.46
| Facility | | $575.44 | $1,230.27 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $630.96 / $812.83 / $1,096.48
| Professional | | $630.96 | $812.83 | $1,096.48 |
- 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
- $588.84 / $1,023.29 / $1,862.09
| Professional | | $588.84 | $1,023.29 | $1,862.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,548.82 / $5,623.41 / $11,220.18
| Facility | | $1,548.82 | $5,623.41 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $562.34 / $912.01 / $5,623.41
| Professional | | $562.34 | $912.01 | $5,623.41 |
- 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
- $630.96 / $891.25 / $1,862.09
| Professional | | $630.96 | $891.25 | $1,862.09 |