- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,318.31 / $6,107.52 / $12,765.09
| Facility | | $2,318.31 | $6,107.52 | $12,765.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $184.52 / $510.29 / $1,662.44
| Professional | | $184.52 | $510.29 | $1,662.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $290.75 / $290.75 / $290.75
| Professional | | $290.75 | $290.75 | $290.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,416.80 / $9,302.56 / $16,325.39
| Facility | | $6,416.80 | $9,302.56 | $16,325.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $192.44 / $437.38 / $1,820.31
| Professional | | $192.44 | $437.38 | $1,820.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $381.52 / $1,549.41 / $3,185.04
| Professional | | $381.52 | $1,549.41 | $3,185.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $192.66 / $923.65 / $3,050.48
| Facility | | $192.66 | $923.65 | $3,050.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,684.65 / $2,573.53 / $7,464.05
| Professional | | $1,684.65 | $2,573.53 | $7,464.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $480.51 / $2,052.38 / $3,185.04
| Facility | | $480.51 | $2,052.38 | $3,185.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $430.85 / $2,052.38 / $3,065.45
| Professional | | $430.85 | $2,052.38 | $3,065.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.00 / $1,263.90 / $4,481.00
| Professional | | $6.00 | $1,263.90 | $4,481.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,341.00 / $7,441.00 / $8,816.00
| Facility | | $5,341.00 | $7,441.00 | $8,816.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,684.65 / $2,385.79 / $3,421.94
| Professional | | $1,684.65 | $2,385.79 | $3,421.94 |