- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $186.21 / $794.33 / $7,244.36
| Facility | | $186.21 | $794.33 | $7,244.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $186.21 / $724.44 / $1,258.93
| Professional | | $186.21 | $724.44 | $1,258.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,073.80 / $6,918.31 / $15,848.93
| Facility | | $4,073.80 | $6,918.31 | $15,848.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $338.84 / $933.25 / $2,398.83
| Professional | | $338.84 | $933.25 | $2,398.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,089.30 / $2,951.21 / $7,079.46
| Facility | | $2,089.30 | $2,951.21 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $457.09 / $1,348.96 / $3,235.94
| Professional | | $457.09 | $1,348.96 | $3,235.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,290.87 / $2,818.38 / $5,495.41
| Facility | | $2,290.87 | $2,818.38 | $5,495.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $426.58 / $1,258.93 / $2,818.38
| Professional | | $426.58 | $1,258.93 | $2,818.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $245.47 / $1,348.96 / $6,760.83
| Facility | | $245.47 | $1,348.96 | $6,760.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $912.01 / $1,698.24 / $3,311.31
| Professional | | $912.01 | $1,698.24 | $3,311.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,884.03 / $5,248.07 / $9,120.11
| Facility | | $2,884.03 | $5,248.07 | $9,120.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.84 / $831.76 / $2,570.40
| Professional | | $281.84 | $831.76 | $2,570.40 |