- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $861.22 / $6,141.01 / $16,762.57
| Facility | | $861.22 | $6,141.01 | $16,762.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $242.29 / $463.17 / $1,343.53
| Professional | | $242.29 | $463.17 | $1,343.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,141.47 / $1,141.47 / $1,141.47
| Professional | | $1,141.47 | $1,141.47 | $1,141.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,442.56 / $3,212.63 / $6,214.26
| Facility | | $2,442.56 | $3,212.63 | $6,214.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $325.74 / $597.82 / $925.17
| Professional | | $325.74 | $597.82 | $925.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $428.67 / $1,020.95 / $1,457.61
| Professional | | $428.67 | $1,020.95 | $1,457.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $443.26 / $824.87 / $2,340.42
| Facility | | $443.26 | $824.87 | $2,340.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $598.99 / $1,023.25 / $3,692.48
| Professional | | $598.99 | $1,023.25 | $3,692.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $584.72 / $924.24 / $1,331.90
| Facility | | $584.72 | $924.24 | $1,331.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $672.15 / $928.82 / $1,340.30
| Professional | | $672.15 | $928.82 | $1,340.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $350.01 / $583.66 / $990.76
| Professional | | $350.01 | $583.66 | $990.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,031.00 / $1,775.00 / $4,406.00
| Facility | | $1,031.00 | $1,775.00 | $4,406.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $598.99 / $1,055.36 / $1,196.36
| Professional | | $598.99 | $1,055.36 | $1,196.36 |