- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $602.56 / $977.24 / $14,454.40
| Facility | | $602.56 | $977.24 | $14,454.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $446.68 / $602.56 / $1,096.48
| Professional | | $446.68 | $602.56 | $1,096.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,011.87 / $7,943.28 / $12,589.25
| Facility | | $5,011.87 | $7,943.28 | $12,589.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $489.78 / $912.01 / $2,818.38
| Professional | | $489.78 | $912.01 | $2,818.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,230.27 / $1,445.44 / $2,290.87
| Facility | | $1,230.27 | $1,445.44 | $2,290.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $831.76 / $1,513.56 / $1,698.24
| Professional | | $831.76 | $1,513.56 | $1,698.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $549.54 / $7,413.10 / $14,454.40
| Facility | | $549.54 | $7,413.10 | $14,454.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,023.29 / $1,258.93 / $1,479.11
| Professional | | $1,023.29 | $1,258.93 | $1,479.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $549.54 / $7,585.78 / $12,589.25
| Facility | | $549.54 | $7,585.78 | $12,589.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $616.60 / $1,023.29 / $2,754.23
| Professional | | $616.60 | $1,023.29 | $2,754.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $33.11 / $70.79
| Professional | | $32.36 | $33.11 | $70.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $707.95 / $1,122.02 / $1,548.82
| Professional | | $707.95 | $1,122.02 | $1,548.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,332.54 / $9,332.54 / $13,803.84
| Facility | | $9,332.54 | $9,332.54 | $13,803.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $831.76 / $2,511.89 / $3,548.13
| Professional | | $831.76 | $2,511.89 | $3,548.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,454.71 / $2,454.71 / $2,454.71
| Professional | | $2,454.71 | $2,454.71 | $2,454.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,754.23 / $3,311.31 / $3,630.78
| Professional | | $2,754.23 | $3,311.31 | $3,630.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,606.93 / $10,232.93 / $12,589.25
| Facility | | $6,606.93 | $10,232.93 | $12,589.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $602.56 / $1,000.00 / $2,290.87
| Professional | | $602.56 | $1,000.00 | $2,290.87 |