- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,318.31 / $7,075.14 / $14,044.98
| Facility | | $2,318.31 | $7,075.14 | $14,044.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $682.71 / $736.58 / $3,024.00
| Professional | | $682.71 | $736.58 | $3,024.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,350.53 / $1,350.53 / $1,350.53
| Professional | | $1,350.53 | $1,350.53 | $1,350.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,183.05 / $10,762.95 / $20,819.02
| Facility | | $8,183.05 | $10,762.95 | $20,819.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $700.01 / $1,193.22 / $1,590.96
| Professional | | $700.01 | $1,193.22 | $1,590.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,266.26 / $5,266.26 / $5,266.26
| Facility | | $5,266.26 | $5,266.26 | $5,266.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,142.00 / $1,735.58 / $2,247.69
| Professional | | $1,142.00 | $1,735.58 | $2,247.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $724.94 / $1,304.89 / $8,892.70
| Facility | | $724.94 | $1,304.89 | $8,892.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $922.86 / $1,510.86 / $2,100.21
| Professional | | $922.86 | $1,510.86 | $2,100.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $953.00 / $1,812.84 / $6,616.19
| Facility | | $953.00 | $1,812.84 | $6,616.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,250.01 / $1,549.49 / $2,207.71
| Professional | | $1,250.01 | $1,549.49 | $2,207.71 |
- 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
- $922.86 / $1,510.86 / $1,968.61
| Professional | | $922.86 | $1,510.86 | $1,968.61 |