- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,905.46 / $6,165.95 / $17,378.01
| Facility | | $1,905.46 | $6,165.95 | $17,378.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $549.54 / $933.25 / $13,489.63
| Professional | | $549.54 | $933.25 | $13,489.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,943.28 / $13,803.84 / $22,387.21
| Facility | | $7,943.28 | $13,803.84 | $22,387.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $426.58 / $794.33 / $2,137.96
| Professional | | $426.58 | $794.33 | $2,137.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $60.26 / $100.00 / $6,456.54
| Facility | | $60.26 | $100.00 | $6,456.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.42 / $398.11 / $707.95
| Professional | | $275.42 | $398.11 | $707.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $89.13 / $630.96 / $831.76
| Professional | | $89.13 | $630.96 | $831.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,309.57 / $6,309.57 / $6,309.57
| Facility | | $6,309.57 | $6,309.57 | $6,309.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,309.57 / $6,309.57 / $6,309.57
| Professional | | $6,309.57 | $6,309.57 | $6,309.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $691.83 / $870.96 / $13,489.63
| Facility | | $691.83 | $870.96 | $13,489.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $630.96 / $645.65 / $2,818.38
| Professional | | $630.96 | $645.65 | $2,818.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $588.84 / $1,584.89 / $6,918.31
| Facility | | $588.84 | $1,584.89 | $6,918.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.42 / $707.95 / $1,513.56
| Professional | | $275.42 | $707.95 | $1,513.56 |