- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $276.23 / $4,518.60 / $12,036.14
| Facility | | $276.23 | $4,518.60 | $12,036.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $164.54 / $347.18 / $1,362.18
| Professional | | $164.54 | $347.18 | $1,362.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $319.18 / $388.86 / $388.86
| Professional | | $319.18 | $388.86 | $388.86 |
- 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
- $173.68 / $335.51 / $560.94
| Professional | | $173.68 | $335.51 | $560.94 |
- 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
- $344.31 / $575.61 / $932.30
| Professional | | $344.31 | $575.61 | $932.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $205.68 / $455.78 / $1,262.08
| Facility | | $205.68 | $455.78 | $1,262.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $641.92 / $964.00 / $1,906.60
| Professional | | $641.92 | $964.00 | $1,906.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $471.82 / $911.19 / $2,842.49
| Facility | | $471.82 | $911.19 | $2,842.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $440.90 / $829.67 / $1,160.83
| Professional | | $440.90 | $829.67 | $1,160.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $186.72 / $325.56 / $592.00
| Professional | | $186.72 | $325.56 | $592.00 |
- 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
- $664.06 / $1,034.92 / $1,486.04
| Professional | | $664.06 | $1,034.92 | $1,486.04 |