- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,651.22 / $4,478.64 / $14,545.70
| Facility | | $1,651.22 | $4,478.64 | $14,545.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,199.89 / $1,651.22 / $1,871.38
| Professional | | $1,199.89 | $1,651.22 | $1,871.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $244.00 / $614.00 / $11,030.12
| Facility | | $244.00 | $614.00 | $11,030.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.34 / $13.57 / $1,342.98
| Professional | | $12.34 | $13.57 | $1,342.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,001.74 / $1,431.05 / $2,046.54
| Professional | | $1,001.74 | $1,431.05 | $2,046.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,452.52 / $2,890.72 / $5,581.10
| Facility | | $1,452.52 | $2,890.72 | $5,581.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,201.69 / $2,752.13 / $3,162.03
| Professional | | $2,201.69 | $2,752.13 | $3,162.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $99.00 / $2,201.62 / $3,522.59
| Professional | | $99.00 | $2,201.62 | $3,522.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,761.30 / $2,201.62 / $3,852.84
| Professional | | $1,761.30 | $2,201.62 | $3,852.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,830.82 / $10,457.70 / $10,457.70
| Facility | | $3,830.82 | $10,457.70 | $10,457.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.00 / $20.00 / $20.00
| Professional | | $20.00 | $20.00 | $20.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,525.15 / $2,069.53 / $3,962.92
| Facility | | $1,525.15 | $2,069.53 | $3,962.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,805.33 / $2,201.62 / $2,421.78
| Professional | | $1,805.33 | $2,201.62 | $2,421.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $924.68 / $924.68 / $4,359.21
| Professional | | $924.68 | $924.68 | $4,359.21 |