- 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
- $512.86 / $741.31 / $1,174.90
| Professional | | $512.86 | $741.31 | $1,174.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,311.31 / $6,606.93 / $18,620.87
| Facility | | $3,311.31 | $6,606.93 | $18,620.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $954.99 / $1,122.02 / $1,148.15
| Professional | | $954.99 | $1,122.02 | $1,148.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,265.80 / $4,265.80 / $4,265.80
| Facility | | $4,265.80 | $4,265.80 | $4,265.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $575.44 / $776.25 / $1,000.00
| Professional | | $575.44 | $776.25 | $1,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $562.34 / $933.25 / $1,479.11
| Facility | | $562.34 | $933.25 | $1,479.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $912.01 / $1,023.29 / $1,380.38
| Professional | | $912.01 | $1,023.29 | $1,380.38 |
- 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
- $12,022.64 / $16,218.10 / $22,908.68
| Facility | | $12,022.64 | $16,218.10 | $22,908.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $794.33 / $1,122.02 / $1,380.38
| Professional | | $794.33 | $1,122.02 | $1,380.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $501.19 / $660.69 / $11,220.18
| Professional | | $501.19 | $660.69 | $11,220.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,570.40 / $11,748.98 / $29,512.09
| Facility | | $2,570.40 | $11,748.98 | $29,512.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $562.34 / $851.14 / $1,174.90
| Professional | | $562.34 | $851.14 | $1,174.90 |