- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $187.74 / $6,629.40 / $12,860.76
| Facility | | $187.74 | $6,629.40 | $12,860.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $80.66 / $351.00 / $10,398.20
| Professional | | $80.66 | $351.00 | $10,398.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $136.32 / $3,943.23 / $11,692.17
| Professional | | $136.32 | $3,943.23 | $11,692.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $158.94 / $233.54 / $9,987.66
| Professional | | $158.94 | $233.54 | $9,987.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $115.16 / $3,747.82 / $12,141.19
| Facility | | $115.16 | $3,747.82 | $12,141.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $137.69 / $6,277.05 / $12,478.01
| Professional | | $137.69 | $6,277.05 | $12,478.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $163.83 / $7,762.94 / $9,578.32
| Facility | | $163.83 | $7,762.94 | $9,578.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $115.16 / $7,285.44 / $12,141.19
| Facility | | $115.16 | $7,285.44 | $12,141.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $165.76 / $6,211.54 / $13,436.35
| Professional | | $165.76 | $6,211.54 | $13,436.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21,539.32 / $27,893.00 / $33,646.87
| Facility | | $21,539.32 | $27,893.00 | $33,646.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $167.68 / $298.42 / $12,360.14
| Professional | | $167.68 | $298.42 | $12,360.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,340.00 / $26,100.00 / $51,981.00
| Facility | | $3,340.00 | $26,100.00 | $51,981.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7,433.93 / $10,224.89 / $13,878.57
| Professional | | $7,433.93 | $10,224.89 | $13,878.57 |