- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,086.69 / $4,182.08 / $13,841.56
| Facility | | $1,086.69 | $4,182.08 | $13,841.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $292.31 / $436.05 / $797.41
| Professional | | $292.31 | $436.05 | $797.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $416.38 / $416.38 / $416.38
| Professional | | $416.38 | $416.38 | $416.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,070.46 / $5,901.02 / $10,355.91
| Facility | | $4,070.46 | $5,901.02 | $10,355.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $330.77 / $607.04 / $894.57
| Professional | | $330.77 | $607.04 | $894.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $456.78 / $1,003.96 / $1,380.95
| Professional | | $456.78 | $1,003.96 | $1,380.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $317.47 / $545.16 / $951.83
| Facility | | $317.47 | $545.16 | $951.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $583.98 / $1,070.85 / $3,522.00
| Professional | | $583.98 | $1,070.85 | $3,522.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $674.27 / $1,036.31 / $2,360.86
| Facility | | $674.27 | $1,036.31 | $2,360.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $615.78 / $875.87 / $1,187.15
| Professional | | $615.78 | $875.87 | $1,187.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.00 / $634.50 / $1,285.20
| Professional | | $5.00 | $634.50 | $1,285.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,217.00 / $6,451.00 / $7,934.00
| Facility | | $4,217.00 | $6,451.00 | $7,934.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $526.46 / $959.75 / $1,173.28
| Professional | | $526.46 | $959.75 | $1,173.28 |