- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,826.25 / $6,362.27 / $17,489.40
| Facility | | $1,826.25 | $6,362.27 | $17,489.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,327.08 / $2,021.05 / $2,069.75
| Professional | | $1,327.08 | $2,021.05 | $2,069.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $244.00 / $614.00 / $12,199.35
| Facility | | $244.00 | $614.00 | $12,199.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $121.34 / $151.66 / $3,725.55
| Professional | | $121.34 | $151.66 | $3,725.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $98.20 / $3,749.90 / $6,696.25
| Facility | | $98.20 | $3,749.90 | $6,696.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,107.93 / $1,582.75 / $3,957.67
| Professional | | $1,107.93 | $1,582.75 | $3,957.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,606.49 / $3,428.24 / $6,172.73
| Facility | | $1,606.49 | $3,428.24 | $6,172.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,435.00 / $2,678.50 / $3,287.25
| Professional | | $2,435.00 | $2,678.50 | $3,287.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,191.50 / $2,800.25 / $4,650.85
| Professional | | $2,191.50 | $2,800.25 | $4,650.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,236.89 / $11,566.25 / $11,566.25
| Facility | | $4,236.89 | $11,566.25 | $11,566.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12,126.30 / $12,126.30 / $18,262.50
| Professional | | $12,126.30 | $12,126.30 | $18,262.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,729.34 / $2,922.00 / $5,423.96
| Facility | | $1,729.34 | $2,922.00 | $5,423.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,435.00 / $2,678.50 / $3,652.50
| Professional | | $2,435.00 | $2,678.50 | $3,652.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,022.70 / $1,064.02 / $5,102.54
| Professional | | $1,022.70 | $1,064.02 | $5,102.54 |