- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $660.69 / $3,090.30 / $23,442.29
| Facility | | $660.69 | $3,090.30 | $23,442.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $323.59 / $1,348.96 / $3,019.95
| Professional | | $323.59 | $1,348.96 | $3,019.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $134.90 / $426.58 / $489.78
| Professional | | $134.90 | $426.58 | $489.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,238.72 / $4,897.79 / $11,748.98
| Facility | | $2,238.72 | $4,897.79 | $11,748.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $363.08 / $707.95 / $2,818.38
| Professional | | $363.08 | $707.95 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $316.23 / $1,862.09 / $2,818.38
| Professional | | $316.23 | $1,862.09 | $2,818.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,488.17 / $17,378.01 / $29,512.09
| Facility | | $15,488.17 | $17,378.01 | $29,512.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $371.54 / $1,047.13 / $3,548.13
| Professional | | $371.54 | $1,047.13 | $3,548.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $371.54 / $1,288.25 / $4,466.84
| Facility | | $371.54 | $1,288.25 | $4,466.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,862.09 / $3,630.78 / $13,182.57
| Professional | | $1,862.09 | $3,630.78 | $13,182.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,584.89 / $1,584.89 / $1,584.89
| Professional | | $1,584.89 | $1,584.89 | $1,584.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $331.13 / $707.95 / $2,041.74
| Facility | | $331.13 | $707.95 | $2,041.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.74 / $1,445.44 / $3,467.37
| Professional | | $346.74 | $1,445.44 | $3,467.37 |