- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,365.16 / $4,466.84 / $5,495.41
| Facility | | $4,365.16 | $4,466.84 | $5,495.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $588.84 / $831.76 / $1,318.26
| Professional | | $588.84 | $831.76 | $1,318.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,570.40 / $10,232.93 / $34,673.69
| Facility | | $2,570.40 | $10,232.93 | $34,673.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,071.52 / $1,258.93 / $1,288.25
| Professional | | $1,071.52 | $1,258.93 | $1,288.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,220.18 / $11,220.18 / $11,220.18
| Facility | | $11,220.18 | $11,220.18 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $645.65 / $870.96 / $1,096.48
| Professional | | $645.65 | $870.96 | $1,096.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $630.96 / $1,071.52 / $1,621.81
| Facility | | $630.96 | $1,071.52 | $1,621.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,000.00 / $1,148.15 / $1,513.56
| Professional | | $1,000.00 | $1,148.15 | $1,513.56 |
- 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
- $23,988.33 / $29,512.09 / $45,708.82
| Facility | | $23,988.33 | $29,512.09 | $45,708.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $891.25 / $1,258.93 / $1,548.82
| Professional | | $891.25 | $1,258.93 | $1,548.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $549.54 / $741.31 / $20,417.38
| Professional | | $549.54 | $741.31 | $20,417.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,089.30 / $10,232.93 / $27,542.29
| Facility | | $2,089.30 | $10,232.93 | $27,542.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $630.96 / $933.25 / $1,318.26
| Professional | | $630.96 | $933.25 | $1,318.26 |