- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,482.90 / $8,042.03 / $19,276.96
| Facility | | $2,482.90 | $8,042.03 | $19,276.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $376.26 / $400.17 / $1,282.00
| Professional | | $376.26 | $400.17 | $1,282.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $935.51 / $935.51 / $935.51
| Professional | | $935.51 | $935.51 | $935.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,003.91 / $9,212.06 / $17,819.09
| Facility | | $7,003.91 | $9,212.06 | $17,819.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $378.25 / $644.76 / $859.69
| Professional | | $378.25 | $644.76 | $859.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,368.73 / $2,368.73 / $2,368.73
| Facility | | $2,368.73 | $2,368.73 | $2,368.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $681.00 / $947.48 / $1,270.21
| Professional | | $681.00 | $947.48 | $1,270.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $387.47 / $683.41 / $5,405.32
| Facility | | $387.47 | $683.41 | $5,405.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $519.57 / $859.58 / $1,177.36
| Professional | | $519.57 | $859.58 | $1,177.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $788.28 / $1,089.00 / $2,961.89
| Facility | | $788.28 | $1,089.00 | $2,961.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $719.19 / $946.13 / $1,270.21
| Professional | | $719.19 | $946.13 | $1,270.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,341.00 / $7,441.00 / $8,816.00
| Facility | | $5,341.00 | $7,441.00 | $8,816.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $519.57 / $883.63 / $1,151.34
| Professional | | $519.57 | $883.63 | $1,151.34 |