- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,650.53 / $8,477.27 / $19,276.96
| Facility | | $1,650.53 | $8,477.27 | $19,276.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $379.91 / $407.80 / $1,488.60
| Professional | | $379.91 | $407.80 | $1,488.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $665.59 / $665.59 / $741.67
| Professional | | $665.59 | $665.59 | $741.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,949.61 / $3,879.54 / $7,504.28
| Facility | | $2,949.61 | $3,879.54 | $7,504.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $396.43 / $675.73 / $900.97
| Professional | | $396.43 | $675.73 | $900.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,257.44 / $1,257.44 / $1,257.44
| Facility | | $1,257.44 | $1,257.44 | $1,257.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $662.00 / $989.45 / $1,309.44
| Professional | | $662.00 | $989.45 | $1,309.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $407.80 / $734.04 / $3,044.00
| Facility | | $407.80 | $734.04 | $3,044.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $535.57 / $897.05 / $1,220.13
| Professional | | $535.57 | $897.05 | $1,220.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $803.00 / $1,101.20 / $1,597.11
| Facility | | $803.00 | $1,101.20 | $1,597.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $735.00 / $995.89 / $1,309.44
| Professional | | $735.00 | $995.89 | $1,309.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,044.00 / $3,726.00 / $7,934.00
| Facility | | $3,044.00 | $3,726.00 | $7,934.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $535.57 / $911.03 / $1,168.83
| Professional | | $535.57 | $911.03 | $1,168.83 |