- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,463.36 / $10,975.77 / $20,928.72
| Facility | | $5,463.36 | $10,975.77 | $20,928.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $347.00 / $400.32 / $851.07
| Professional | | $347.00 | $400.32 | $851.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $562.84 / $562.84 / $562.84
| Professional | | $562.84 | $562.84 | $562.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,838.93 / $11,364.26 / $19,943.52
| Facility | | $7,838.93 | $11,364.26 | $19,943.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $360.91 / $615.16 / $820.24
| Professional | | $360.91 | $615.16 | $820.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $514.07 / $894.61 / $1,298.33
| Professional | | $514.07 | $894.61 | $1,298.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $372.58 / $633.39 / $1,272.00
| Facility | | $372.58 | $633.39 | $1,272.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $570.20 / $854.15 / $7,231.97
| Professional | | $570.20 | $854.15 | $7,231.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $678.32 / $1,010.36 / $6,141.94
| Facility | | $678.32 | $1,010.36 | $6,141.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $594.95 / $882.78 / $1,199.34
| Professional | | $594.95 | $882.78 | $1,199.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.00 / $546.20 / $1,073.80
| Professional | | $5.00 | $546.20 | $1,073.80 |
- 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
- $543.91 / $886.08 / $1,000.34
| Professional | | $543.91 | $886.08 | $1,000.34 |