- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,388.44 / $4,466.84 / $5,495.41
| Facility | | $3,388.44 | $4,466.84 | $5,495.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.74 / $501.19 / $1,202.26
| Professional | | $346.74 | $501.19 | $1,202.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,187.76 / $3,981.07 / $16,982.44
| Facility | | $2,187.76 | $3,981.07 | $16,982.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $676.08 / $794.33 / $812.83
| Professional | | $676.08 | $794.33 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $363.08 / $602.56 / $831.76
| Professional | | $363.08 | $602.56 | $831.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $407.38 / $630.96 / $1,202.26
| Facility | | $407.38 | $630.96 | $1,202.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $426.58 / $724.44 / $851.14
| Professional | | $426.58 | $724.44 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $32.36 / $33.11
| Professional | | $32.36 | $32.36 | $33.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,585.78 / $14,454.40 / $23,988.33
| Facility | | $7,585.78 | $14,454.40 | $23,988.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $616.60 / $794.33 / $870.96
| Professional | | $616.60 | $794.33 | $870.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $371.54 / $416.87 / $10,000.00
| Professional | | $371.54 | $416.87 | $10,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,332.54 / $16,982.44 / $18,197.01
| Facility | | $9,332.54 | $16,982.44 | $18,197.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $398.11 / $562.34 / $831.76
| Professional | | $398.11 | $562.34 | $831.76 |