- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,884.03 / $4,466.84 / $5,495.41
| Facility | | $2,884.03 | $4,466.84 | $5,495.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $407.38 / $512.86 / $1,148.15
| Professional | | $407.38 | $512.86 | $1,148.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,244.36 / $15,488.17 / $64,565.42
| Facility | | $7,244.36 | $15,488.17 | $64,565.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $588.84 / $691.83 / $724.44
| Professional | | $588.84 | $691.83 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $501.19 / $645.65 / $776.25
| Professional | | $501.19 | $645.65 | $776.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $457.09 / $776.25 / $5,495.41
| Facility | | $457.09 | $776.25 | $5,495.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $549.54 / $630.96 / $776.25
| Professional | | $549.54 | $630.96 | $776.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $32.36 / $33.11
| Professional | | $32.36 | $32.36 | $33.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $42,657.95 / $58,884.37 / $79,432.82
| Facility | | $42,657.95 | $58,884.37 | $79,432.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $724.44 / $741.31 / $812.83
| Professional | | $724.44 | $741.31 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $302.00 / $323.59 / $57,543.99
| Professional | | $302.00 | $323.59 | $57,543.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,454.40 / $112,201.85 / $165,958.69
| Facility | | $14,454.40 | $112,201.85 | $165,958.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $407.38 / $549.54 / $794.33
| Professional | | $407.38 | $549.54 | $794.33 |