- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,793.50 / $4,882.60 / $8,456.50
| Facility | | $1,793.50 | $4,882.60 | $8,456.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $648.79 / $4,513.35 / $6,085.66
| Professional | | $648.79 | $4,513.35 | $6,085.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $65.90 / $100.00 / $17,058.50
| Facility | | $65.90 | $100.00 | $17,058.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,594.88 / $17,010.84 / $20,924.30
| Facility | | $13,594.88 | $17,010.84 | $20,924.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,459.68 / $15,259.06 / $30,518.12
| Facility | | $8,459.68 | $15,259.06 | $30,518.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,526.00 / $9,992.00 / $17,206.00
| Facility | | $7,526.00 | $9,992.00 | $17,206.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $596.25 / $1,267.14 / $1,605.60
| Professional | | $596.25 | $1,267.14 | $1,605.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $620.79 / $620.79 / $620.79
| Professional | | $620.79 | $620.79 | $620.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,121.53 / $7,659.89 / $8,123.88
| Professional | | $1,121.53 | $7,659.89 | $8,123.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $113.73 / $811.41 / $12,680.53
| Professional | | $113.73 | $811.41 | $12,680.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,572.18 / $15,409.23 / $15,409.23
| Facility | | $13,572.18 | $15,409.23 | $15,409.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13,369.88 / $13,369.88 / $16,712.34
| Professional | | $13,369.88 | $13,369.88 | $16,712.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,074.00 / $10,242.00 / $19,477.00
| Facility | | $5,074.00 | $10,242.00 | $19,477.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $492.02 / $931.74 / $2,735.41
| Professional | | $492.02 | $931.74 | $2,735.41 |