- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $451.22 / $7,119.04 / $19,276.96
| Facility | | $451.22 | $7,119.04 | $19,276.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $289.20 / $423.48 / $1,782.19
| Professional | | $289.20 | $423.48 | $1,782.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $614.12 / $614.12 / $614.12
| Professional | | $614.12 | $614.12 | $614.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,712.35 / $6,198.03 / $11,988.99
| Facility | | $4,712.35 | $6,198.03 | $11,988.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $333.11 / $616.61 / $924.80
| Professional | | $333.11 | $616.61 | $924.80 |
- 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
- $579.44 / $960.27 / $1,408.22
| Professional | | $579.44 | $960.27 | $1,408.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $370.99 / $594.48 / $2,094.50
| Facility | | $370.99 | $594.48 | $2,094.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $611.94 / $1,012.05 / $2,532.56
| Professional | | $611.94 | $1,012.05 | $2,532.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $745.27 / $1,061.11 / $2,842.49
| Facility | | $745.27 | $1,061.11 | $2,842.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $690.60 / $911.04 / $1,298.27
| Professional | | $690.60 | $911.04 | $1,298.27 |
- 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
- $611.94 / $941.44 / $1,318.02
| Professional | | $611.94 | $941.44 | $1,318.02 |