- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,778.28 / $3,630.78 / $6,760.83
| Facility | | $1,778.28 | $3,630.78 | $6,760.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $707.95 / $3,548.13 / $19,498.45
| Professional | | $707.95 | $3,548.13 | $19,498.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $5,128.61 / $26,302.68
| Facility | | $56.23 | $5,128.61 | $26,302.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $676.08 / $5,248.07 / $19,054.61
| Professional | | $676.08 | $5,248.07 | $19,054.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $724.44 / $724.44 / $1,698.24
| Facility | | $724.44 | $724.44 | $1,698.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $933.25 / $4,786.30 / $18,197.01
| Professional | | $933.25 | $4,786.30 | $18,197.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $501.19 / $1,174.90 / $7,079.46
| Facility | | $501.19 | $1,174.90 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7,585.78 / $9,332.54 / $16,595.87
| Professional | | $7,585.78 | $9,332.54 | $16,595.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,691.53 / $6,918.31 / $20,417.38
| Facility | | $2,691.53 | $6,918.31 | $20,417.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $691.83 / $6,309.57 / $16,218.10
| Professional | | $691.83 | $6,309.57 | $16,218.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $5,128.61 / $26,302.68
| Facility | | $56.23 | $5,128.61 | $26,302.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $676.08 / $5,248.07 / $19,054.61
| Professional | | $676.08 | $5,248.07 | $19,054.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,951.21 / $7,244.36 / $29,512.09
| Facility | | $2,951.21 | $7,244.36 | $29,512.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $851.14 / $7,413.10 / $18,197.01
| Professional | | $851.14 | $7,413.10 | $18,197.01 |