- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $660.69 / $3,090.30 / $8,511.38
| Facility | | $660.69 | $3,090.30 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $154.88 / $1,047.13 / $4,897.79
| Professional | | $154.88 | $1,047.13 | $4,897.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,125.38 / $14,125.38 / $57,543.99
| Facility | | $14,125.38 | $14,125.38 | $57,543.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,137.96 / $2,511.89 / $4,786.30
| Professional | | $2,137.96 | $2,511.89 | $4,786.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $186.21 / $2,089.30 / $5,128.61
| Professional | | $186.21 | $2,089.30 | $5,128.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,162.28 / $3,981.07 / $4,466.84
| Professional | | $3,162.28 | $3,981.07 | $4,466.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $190.55 / $3,235.94 / $4,570.88
| Professional | | $190.55 | $3,235.94 | $4,570.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,606.93 / $15,135.61 / $16,218.10
| Facility | | $6,606.93 | $15,135.61 | $16,218.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $537.03 / $2,691.53 / $8,317.64
| Facility | | $537.03 | $2,691.53 | $8,317.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $158.49 / $1,230.27 / $6,025.60
| Professional | | $158.49 | $1,230.27 | $6,025.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,165.95 / $6,165.95 / $6,165.95
| Facility | | $6,165.95 | $6,165.95 | $6,165.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.01 / $4,570.88 / $5,495.41
| Professional | | $5.01 | $4,570.88 | $5,495.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $169.82 / $190.55 / $3,235.94
| Facility | | $169.82 | $190.55 | $3,235.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $165.96 / $407.38 / $2,884.03
| Professional | | $165.96 | $407.38 | $2,884.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,344.23 / $4,466.84 / $18,197.01
| Facility | | $2,344.23 | $4,466.84 | $18,197.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.78 / $1,513.56 / $5,128.61
| Professional | | $173.78 | $1,513.56 | $5,128.61 |