- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $221.84 / $4,358.30 / $15,095.33
| Facility | | $221.84 | $4,358.30 | $15,095.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $157.83 / $2,344.31 / $4,766.38
| Professional | | $157.83 | $2,344.31 | $4,766.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,213.32 / $15,599.20 / $31,745.76
| Facility | | $1,213.32 | $15,599.20 | $31,745.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $314.67 / $3,276.49 / $19,789.59
| Professional | | $314.67 | $3,276.49 | $19,789.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,024.01 / $6,024.01 / $10,035.93
| Facility | | $6,024.01 | $6,024.01 | $10,035.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $279.44 / $576.55 / $8,308.62
| Professional | | $279.44 | $576.55 | $8,308.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $270.86 / $4,789.88 / $9,346.87
| Facility | | $270.86 | $4,789.88 | $9,346.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $270.86 / $4,112.70 / $8,801.18
| Professional | | $270.86 | $4,112.70 | $8,801.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $645.89 / $4,167.86 / $6,511.33
| Professional | | $645.89 | $4,167.86 | $6,511.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $337.55 / $5,053.71 / $5,904.36
| Facility | | $337.55 | $5,053.71 | $5,904.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,681.14 / $3,751.64 / $3,850.95
| Facility | | $3,681.14 | $3,751.64 | $3,850.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $298.27 / $577.08 / $7,195.00
| Professional | | $298.27 | $577.08 | $7,195.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,109.64 / $16,595.73 / $31,745.76
| Facility | | $12,109.64 | $16,595.73 | $31,745.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $279.48 / $3,338.34 / $6,250.36
| Professional | | $279.48 | $3,338.34 | $6,250.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,912.00 / $3,509.00 / $17,644.00
| Facility | | $2,912.00 | $3,509.00 | $17,644.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,188.81 / $6,006.64 / $9,065.76
| Professional | | $4,188.81 | $6,006.64 | $9,065.76 |