- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,949.84 / $7,413.10 / $12,589.25
| Facility | | $1,949.84 | $7,413.10 | $12,589.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.81 / $954.99 / $2,398.83
| Professional | | $354.81 | $954.99 | $2,398.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $190.55 / $190.55 / $190.55
| Professional | | $190.55 | $190.55 | $190.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,128.61 / $6,606.93 / $12,882.50
| Facility | | $5,128.61 | $6,606.93 | $12,882.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $436.52 / $870.96 / $1,905.46
| Professional | | $436.52 | $870.96 | $1,905.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $398.11 / $1,023.29 / $2,570.40
| Professional | | $398.11 | $1,023.29 | $2,570.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.11 / $1,148.15 / $4,786.30
| Facility | | $398.11 | $1,148.15 | $4,786.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,174.90 / $1,819.70 / $7,244.36
| Professional | | $1,174.90 | $1,819.70 | $7,244.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $758.58 / $2,041.74 / $2,570.40
| Professional | | $758.58 | $2,041.74 | $2,570.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $912.01 / $912.01 / $2,137.96
| Professional | | $912.01 | $912.01 | $2,137.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.01 / $436.52 / $2,691.53
| Professional | | $5.01 | $436.52 | $2,691.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,630.27 / $3,715.35 / $8,128.31
| Facility | | $2,630.27 | $3,715.35 | $8,128.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $446.68 / $1,096.48 / $2,290.87
| Professional | | $446.68 | $1,096.48 | $2,290.87 |