- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,241.22 / $9,544.15 / $20,928.72
| Facility | | $4,241.22 | $9,544.15 | $20,928.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $305.52 / $484.13 / $2,275.66
| Professional | | $305.52 | $484.13 | $2,275.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $550.02 / $550.02 / $550.02
| Professional | | $550.02 | $550.02 | $550.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,193.47 / $8,393.75 / $15,757.21
| Facility | | $6,193.47 | $8,393.75 | $15,757.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $381.02 / $689.00 / $986.62
| Professional | | $381.02 | $689.00 | $986.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $860.99 / $1,194.92 / $1,620.25
| Professional | | $860.99 | $1,194.92 | $1,620.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $459.08 / $823.02 / $7,363.97
| Facility | | $459.08 | $823.02 | $7,363.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $779.81 / $1,250.51 / $3,936.22
| Professional | | $779.81 | $1,250.51 | $3,936.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $860.99 / $1,207.83 / $5,251.23
| Facility | | $860.99 | $1,207.83 | $5,251.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $839.06 / $1,137.46 / $1,464.07
| Professional | | $839.06 | $1,137.46 | $1,464.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.00 / $605.60 / $1,352.50
| Professional | | $5.00 | $605.60 | $1,352.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,178.00 / $7,441.00 / $8,816.00
| Facility | | $6,178.00 | $7,441.00 | $8,816.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $768.67 / $1,224.84 / $1,559.63
| Professional | | $768.67 | $1,224.84 | $1,559.63 |