- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,659.59 / $13,489.63 / $33,884.42
| Facility | | $1,659.59 | $13,489.63 | $33,884.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,174.90 / $1,659.59 / $2,570.40
| Professional | | $1,174.90 | $1,659.59 | $2,570.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,819.70 / $1,819.70 / $1,819.70
| Facility | | $1,819.70 | $1,819.70 | $1,819.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8,511.38 / $8,511.38 / $8,511.38
| Professional | | $8,511.38 | $8,511.38 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,691.53 / $3,548.13 / $4,073.80
| Professional | | $2,691.53 | $3,548.13 | $4,073.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,659.59 / $2,290.87 / $19,054.61
| Facility | | $1,659.59 | $2,290.87 | $19,054.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,230.27 / $2,398.83 / $13,489.63
| Professional | | $1,230.27 | $2,398.83 | $13,489.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,995.26 / $2,951.21 / $6,456.54
| Facility | | $1,995.26 | $2,951.21 | $6,456.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,230.27 / $2,041.74 / $3,162.28
| Facility | | $1,230.27 | $2,041.74 | $3,162.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $70.79 / $79.43 / $8,511.38
| Professional | | $70.79 | $79.43 | $8,511.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,019.95 / $7,413.10 / $602,559.59
| Facility | | $3,019.95 | $7,413.10 | $602,559.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,090.30 / $3,630.78 / $5,011.87
| Professional | | $3,090.30 | $3,630.78 | $5,011.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,413.10 / $57,543.99 / $91,201.08
| Facility | | $7,413.10 | $57,543.99 | $91,201.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,238.72 / $3,467.37 / $5,248.07
| Professional | | $2,238.72 | $3,467.37 | $5,248.07 |