- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,701.66 / $6,732.07 / $16,762.57
| Facility | | $3,701.66 | $6,732.07 | $16,762.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $374.00 / $827.09 / $1,926.00
| Professional | | $374.00 | $827.09 | $1,926.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $565.32 / $565.32 / $730.86
| Professional | | $565.32 | $565.32 | $730.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,398.31 / $3,250.33 / $6,101.70
| Facility | | $2,398.31 | $3,250.33 | $6,101.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $396.95 / $693.29 / $959.61
| Professional | | $396.95 | $693.29 | $959.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $902.72 / $1,174.78 / $1,457.89
| Professional | | $902.72 | $1,174.78 | $1,457.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $468.99 / $797.28 / $5,076.00
| Facility | | $468.99 | $797.28 | $5,076.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $584.73 / $1,115.04 / $3,814.08
| Professional | | $584.73 | $1,115.04 | $3,814.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $853.27 / $1,148.47 / $2,691.59
| Facility | | $853.27 | $1,148.47 | $2,691.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $729.97 / $1,014.22 / $1,395.20
| Professional | | $729.97 | $1,014.22 | $1,395.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.00 / $555.00 / $1,354.90
| Professional | | $3.00 | $555.00 | $1,354.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,217.00 / $6,451.00 / $7,934.00
| Facility | | $4,217.00 | $6,451.00 | $7,934.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $612.57 / $1,070.89 / $1,211.40
| Professional | | $612.57 | $1,070.89 | $1,211.40 |