- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $812.83 / $1,513.56 / $14,454.40
| Facility | | $812.83 | $1,513.56 | $14,454.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $691.83 / $831.76 / $1,548.82
| Professional | | $691.83 | $831.76 | $1,548.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,011.87 / $8,317.64 / $13,803.84
| Facility | | $5,011.87 | $8,317.64 | $13,803.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $707.95 / $1,380.38 / $3,630.78
| Professional | | $707.95 | $1,380.38 | $3,630.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,905.46 / $2,238.72 / $3,548.13
| Facility | | $1,905.46 | $2,238.72 | $3,548.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $776.25 / $1,621.81 / $3,090.30
| Professional | | $776.25 | $1,621.81 | $3,090.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $707.95 / $954.99 / $3,548.13
| Facility | | $707.95 | $954.99 | $3,548.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,288.25 / $1,621.81 / $2,454.71
| Professional | | $1,288.25 | $1,621.81 | $2,454.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $741.31 / $977.24 / $5,754.40
| Facility | | $741.31 | $977.24 | $5,754.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $741.31 / $1,288.25 / $5,623.41
| Professional | | $741.31 | $1,288.25 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $33.11 / $70.79
| Professional | | $32.36 | $33.11 | $70.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $954.99 / $1,737.80 / $2,691.53
| Professional | | $954.99 | $1,737.80 | $2,691.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,905.46 / $6,165.95 / $6,165.95
| Facility | | $1,905.46 | $6,165.95 | $6,165.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $758.58 / $3,630.78 / $5,495.41
| Professional | | $758.58 | $3,630.78 | $5,495.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,691.53 / $2,691.53 / $2,691.53
| Professional | | $2,691.53 | $2,691.53 | $2,691.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,290.87 / $2,754.23 / $3,715.35
| Professional | | $2,290.87 | $2,754.23 | $3,715.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,290.87 / $6,165.95 / $19,498.45
| Facility | | $2,290.87 | $6,165.95 | $19,498.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $724.44 / $1,023.29 / $2,754.23
| Professional | | $724.44 | $1,023.29 | $2,754.23 |