- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,796.05 / $12,036.14 / $24,179.52
| Facility | | $4,796.05 | $12,036.14 | $24,179.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $266.14 / $1,263.61 / $2,415.60
| Professional | | $266.14 | $1,263.61 | $2,415.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $255.73 / $255.73 / $623.11
| Professional | | $255.73 | $255.73 | $623.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,165.50 / $10,739.86 / $20,774.36
| Facility | | $8,165.50 | $10,739.86 | $20,774.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $279.02 / $634.15 / $2,493.02
| Professional | | $279.02 | $634.15 | $2,493.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $630.29 / $1,489.11 / $4,268.64
| Professional | | $630.29 | $1,489.11 | $4,268.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $339.33 / $1,895.43 / $8,440.16
| Facility | | $339.33 | $1,895.43 | $8,440.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,832.14 / $3,020.63 / $4,979.31
| Professional | | $1,832.14 | $3,020.63 | $4,979.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $694.07 / $2,791.10 / $5,346.70
| Facility | | $694.07 | $2,791.10 | $5,346.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $631.73 / $2,455.91 / $3,824.56
| Professional | | $631.73 | $2,455.91 | $3,824.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $299.20 / $575.39 / $2,555.53
| Professional | | $299.20 | $575.39 | $2,555.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,777.00 / $8,220.00 / $9,696.00
| Facility | | $6,777.00 | $8,220.00 | $9,696.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,114.01 / $3,020.63 / $3,935.80
| Professional | | $2,114.01 | $3,020.63 | $3,935.80 |