- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,467.37 / $8,912.51 / $19,952.62
| Facility | | $3,467.37 | $8,912.51 | $19,952.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.36 / $309.03 / $6,025.60
| Professional | | $151.36 | $309.03 | $6,025.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,311.31 / $7,943.28 / $13,803.84
| Facility | | $3,311.31 | $7,943.28 | $13,803.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $190.55 / $190.55 / $190.55
| Professional | | $190.55 | $190.55 | $190.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $66.07 / $5,495.41 / $14,791.08
| Facility | | $66.07 | $5,495.41 | $14,791.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $630.96 / $1,023.29 / $13,489.63
| Facility | | $630.96 | $1,023.29 | $13,489.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,621.81 / $1,621.81 / $1,621.81
| Professional | | $1,621.81 | $1,621.81 | $1,621.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $128.82 / $281.84 / $831.76
| Professional | | $128.82 | $281.84 | $831.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,818.38 / $10,232.93 / $10,232.93
| Facility | | $2,818.38 | $10,232.93 | $10,232.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,311.31 / $3,311.31 / $3,311.31
| Professional | | $3,311.31 | $3,311.31 | $3,311.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $630.96 / $776.25 / $14,791.08
| Facility | | $630.96 | $776.25 | $14,791.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.26 / $79.43 / $1,621.81
| Professional | | $60.26 | $79.43 | $1,621.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,248.07 / $11,748.98 / $25,118.86
| Facility | | $5,248.07 | $11,748.98 | $25,118.86 |