- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $559.23 / $7,119.04 / $19,276.96
| Facility | | $559.23 | $7,119.04 | $19,276.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $404.53 / $559.23 / $2,247.83
| Professional | | $404.53 | $559.23 | $2,247.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $596.51 / $596.51 / $596.51
| Professional | | $596.51 | $596.51 | $596.51 |
- 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
- $432.73 / $794.15 / $1,146.14
| Professional | | $432.73 | $794.15 | $1,146.14 |
- 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
- $658.84 / $1,176.13 / $1,740.31
| Professional | | $658.84 | $1,176.13 | $1,740.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $480.24 / $768.61 / $2,070.08
| Facility | | $480.24 | $768.61 | $2,070.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $756.03 / $1,250.34 / $3,291.68
| Professional | | $756.03 | $1,250.34 | $3,291.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $933.25 / $1,316.00 / $2,842.49
| Facility | | $933.25 | $1,316.00 | $2,842.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $853.00 / $1,153.88 / $1,612.93
| Professional | | $853.00 | $1,153.88 | $1,612.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $465.29 / $811.27 / $1,211.78
| Professional | | $465.29 | $811.27 | $1,211.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,529.66 / $5,356.00 / $7,934.00
| Facility | | $2,529.66 | $5,356.00 | $7,934.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $634.09 / $964.62 / $1,444.49
| Professional | | $634.09 | $964.62 | $1,444.49 |