- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,327.86 / $4,625.99 / $12,716.50
| Facility | | $1,327.86 | $4,625.99 | $12,716.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $964.91 / $1,469.50 / $1,504.91
| Professional | | $964.91 | $1,469.50 | $1,504.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $244.00 / $614.00 / $8,870.10
| Facility | | $244.00 | $614.00 | $8,870.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.20 / $39.84 / $2,567.19
| Professional | | $33.20 | $39.84 | $2,567.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $98.20 / $2,726.54 / $4,868.82
| Facility | | $98.20 | $2,726.54 | $4,868.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $805.57 / $1,150.81 / $2,877.60
| Professional | | $805.57 | $1,150.81 | $2,877.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,168.07 / $2,492.65 / $4,488.16
| Facility | | $1,168.07 | $2,492.65 | $4,488.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,770.48 / $1,947.53 / $2,390.15
| Professional | | $1,770.48 | $1,947.53 | $2,390.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,593.43 / $2,036.05 / $3,381.62
| Professional | | $1,593.43 | $2,036.05 | $3,381.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,080.64 / $8,409.78 / $8,409.78
| Facility | | $3,080.64 | $8,409.78 | $8,409.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8,816.99 / $8,816.99 / $13,278.60
| Professional | | $8,816.99 | $8,816.99 | $13,278.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,257.39 / $2,124.58 / $3,943.74
| Facility | | $1,257.39 | $2,124.58 | $3,943.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,770.48 / $1,947.53 / $2,655.72
| Professional | | $1,770.48 | $1,947.53 | $2,655.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $743.60 / $773.65 / $4,263.14
| Professional | | $743.60 | $773.65 | $4,263.14 |