- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,162.28 / $7,943.28 / $11,481.54
| Facility | | $3,162.28 | $7,943.28 | $11,481.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $223.87 / $616.60 / $3,630.78
| Professional | | $223.87 | $616.60 | $3,630.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $218.78 / $346.74 / $1,737.80
| Professional | | $218.78 | $346.74 | $1,737.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,754.40 / $7,244.36 / $14,791.08
| Facility | | $5,754.40 | $7,244.36 | $14,791.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,862.09 / $3,162.28 / $4,265.80
| Professional | | $1,862.09 | $3,162.28 | $4,265.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $323.59 / $691.83 / $4,786.30
| Professional | | $323.59 | $691.83 | $4,786.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $239.88 / $3,019.95 / $7,943.28
| Facility | | $239.88 | $3,019.95 | $7,943.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,398.83 / $3,548.13 / $15,488.17
| Professional | | $2,398.83 | $3,548.13 | $15,488.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $575.44 / $3,981.07 / $5,011.87
| Professional | | $575.44 | $3,981.07 | $5,011.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $524.81 / $524.81 / $4,365.16
| Professional | | $524.81 | $524.81 | $4,365.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.98 / $630.96 / $6,165.95
| Professional | | $3.98 | $630.96 | $6,165.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,677.35 / $6,606.93 / $8,912.51
| Facility | | $4,677.35 | $6,606.93 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $338.84 / $2,290.87 / $4,570.88
| Professional | | $338.84 | $2,290.87 | $4,570.88 |