- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,397.42 / $4,868.29 / $13,382.60
| Facility | | $1,397.42 | $4,868.29 | $13,382.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,015.46 / $1,546.47 / $1,583.74
| Professional | | $1,015.46 | $1,546.47 | $1,583.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $244.00 / $614.00 / $9,334.73
| Facility | | $244.00 | $614.00 | $9,334.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.00 / $249.60 / $2,850.72
| Professional | | $208.00 | $249.60 | $2,850.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $98.20 / $2,869.36 / $5,123.85
| Facility | | $98.20 | $2,869.36 | $5,123.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $847.76 / $1,211.08 / $3,028.33
| Professional | | $847.76 | $1,211.08 | $3,028.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,229.26 / $2,623.22 / $4,723.25
| Facility | | $1,229.26 | $2,623.22 | $4,723.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,863.22 / $2,049.54 / $2,515.35
| Professional | | $1,863.22 | $2,049.54 | $2,515.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,676.90 / $2,142.69 / $3,558.75
| Professional | | $1,676.90 | $2,142.69 | $3,558.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,242.00 / $8,850.29 / $8,850.29
| Facility | | $3,242.00 | $8,850.29 | $8,850.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9,278.84 / $9,278.84 / $13,974.15
| Professional | | $9,278.84 | $9,278.84 | $13,974.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,323.26 / $2,235.86 / $4,150.34
| Facility | | $1,323.26 | $2,235.86 | $4,150.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,863.22 / $2,049.54 / $2,794.83
| Professional | | $1,863.22 | $2,049.54 | $2,794.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $782.55 / $782.55 / $4,486.45
| Professional | | $782.55 | $782.55 | $4,486.45 |