- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $903.46 / $4,156.50 / $8,364.50
| Facility | | $903.46 | $4,156.50 | $8,364.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $499.71 / $805.35 / $1,357.35
| Professional | | $499.71 | $805.35 | $1,357.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,261.00 / $7,177.50 / $11,694.50
| Facility | | $4,261.00 | $7,177.50 | $11,694.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,015.90 / $7,314.67 / $14,634.96
| Facility | | $4,015.90 | $7,314.67 | $14,634.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $69.80 / $1,456.27 / $8,343.54
| Facility | | $69.80 | $1,456.27 | $8,343.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,756.66 / $8,929.20 / $10,983.43
| Facility | | $7,756.66 | $8,929.20 | $10,983.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $753.15 / $862.39 / $1,166.15
| Professional | | $753.15 | $862.39 | $1,166.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $374.39 / $784.43 / $894.01
| Professional | | $374.39 | $784.43 | $894.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $303.24 / $433.20 / $953.04
| Professional | | $303.24 | $433.20 | $953.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,060.48 / $1,060.48 / $1,291.02
| Professional | | $1,060.48 | $1,060.48 | $1,291.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $255.00 / $617.95 / $617.95
| Professional | | $255.00 | $617.95 | $617.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $658.93 / $763.50 / $1,294.84
| Facility | | $658.93 | $763.50 | $1,294.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,133.27 / $1,357.79 / $1,787.15
| Professional | | $1,133.27 | $1,357.79 | $1,787.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,454.50 / $4,276.00 / $8,976.50
| Facility | | $1,454.50 | $4,276.00 | $8,976.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $335.51 / $762.96 / $1,504.84
| Professional | | $335.51 | $762.96 | $1,504.84 |