- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $794.33 / $4,073.80 / $8,511.38
| Facility | | $794.33 | $4,073.80 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $371.54 / $1,380.38 / $4,466.84
| Professional | | $371.54 | $1,380.38 | $4,466.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,456.54 / $7,585.78 / $57,543.99
| Facility | | $6,456.54 | $7,585.78 | $57,543.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,202.26 / $2,344.23 / $3,235.94
| Professional | | $1,202.26 | $2,344.23 | $3,235.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $398.11 / $776.25 / $2,754.23
| Professional | | $398.11 | $776.25 | $2,754.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,344.23 / $2,344.23 / $2,398.83
| Professional | | $2,344.23 | $2,344.23 | $2,398.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $457.09 / $1,862.09 / $3,019.95
| Professional | | $457.09 | $1,862.09 | $3,019.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,981.07 / $7,762.47 / $14,454.40
| Facility | | $3,981.07 | $7,762.47 | $14,454.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $363.08 / $363.08 / $389.05
| Professional | | $363.08 | $363.08 | $389.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $794.33 / $3,801.89 / $8,317.64
| Facility | | $794.33 | $3,801.89 | $8,317.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $380.19 / $1,412.54 / $3,801.89
| Professional | | $380.19 | $1,412.54 | $3,801.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.01 / $398.11 / $4,265.80
| Professional | | $5.01 | $398.11 | $4,265.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $331.13 / $1,445.44 / $1,479.11
| Facility | | $331.13 | $1,445.44 | $1,479.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $323.59 / $1,445.44 / $1,479.11
| Professional | | $323.59 | $1,445.44 | $1,479.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,137.96 / $3,981.07 / $9,772.37
| Facility | | $2,137.96 | $3,981.07 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $363.08 / $1,148.15 / $2,754.23
| Professional | | $363.08 | $1,148.15 | $2,754.23 |