- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,506.15 / $5,463.36 / $13,841.56
| Facility | | $1,506.15 | $5,463.36 | $13,841.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $212.29 / $1,098.39 / $2,153.38
| Professional | | $212.29 | $1,098.39 | $2,153.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $379.92 / $379.92 / $379.92
| Professional | | $379.92 | $379.92 | $379.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,172.22 / $19,955.61 / $38,600.60
| Facility | | $15,172.22 | $19,955.61 | $38,600.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $223.30 / $507.50 / $2,172.52
| Professional | | $223.30 | $507.50 | $2,172.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $504.86 / $1,322.57 / $3,755.66
| Professional | | $504.86 | $1,322.57 | $3,755.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $270.67 / $1,647.59 / $2,934.22
| Facility | | $270.67 | $1,647.59 | $2,934.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,596.96 / $2,834.38 / $10,801.34
| Professional | | $1,596.96 | $2,834.38 | $10,801.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $521.10 / $2,140.17 / $3,499.11
| Facility | | $521.10 | $2,140.17 | $3,499.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $521.10 / $2,462.87 / $3,499.11
| Professional | | $521.10 | $2,462.87 | $3,499.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $240.27 / $462.06 / $2,242.66
| Professional | | $240.27 | $462.06 | $2,242.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,031.00 / $1,775.00 / $4,406.00
| Facility | | $1,031.00 | $1,775.00 | $4,406.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,596.96 / $2,727.11 / $3,172.12
| Professional | | $1,596.96 | $2,727.11 | $3,172.12 |