- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,653.00 / $4,518.60 / $13,841.56
| Facility | | $1,653.00 | $4,518.60 | $13,841.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $212.82 / $496.85 / $1,233.80
| Professional | | $212.82 | $496.85 | $1,233.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $187.03 / $187.03 / $411.06
| Professional | | $187.03 | $187.03 | $411.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,665.88 / $3,864.78 / $6,782.44
| Facility | | $2,665.88 | $3,864.78 | $6,782.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $733.86 / $1,238.50 / $1,667.83
| Professional | | $733.86 | $1,238.50 | $1,667.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $336.64 / $1,134.24 / $2,314.90
| Professional | | $336.64 | $1,134.24 | $2,314.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $212.82 / $770.34 / $1,516.82
| Facility | | $212.82 | $770.34 | $1,516.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,100.27 / $1,661.98 / $6,034.32
| Professional | | $1,100.27 | $1,661.98 | $6,034.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $619.82 / $1,265.92 / $2,097.69
| Facility | | $619.82 | $1,265.92 | $2,097.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $546.79 / $1,309.69 / $2,167.71
| Professional | | $546.79 | $1,309.69 | $2,167.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $225.72 / $475.10 / $1,698.54
| Professional | | $225.72 | $475.10 | $1,698.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,044.00 / $3,726.00 / $7,934.00
| Facility | | $3,044.00 | $3,726.00 | $7,934.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $447.42 / $1,449.42 / $1,953.32
| Professional | | $447.42 | $1,449.42 | $1,953.32 |