- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $477.15 / $2,612.27 / $7,263.00
| Facility | | $477.15 | $2,612.27 | $7,263.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $217.50 / $418.39 / $3,018.31
| Professional | | $217.50 | $418.39 | $3,018.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,639.91 / $11,851.00 / $28,970.26
| Facility | | $8,639.91 | $11,851.00 | $28,970.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,607.88 / $3,223.81 / $4,994.10
| Professional | | $1,607.88 | $3,223.81 | $4,994.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $256.79 / $503.79 / $3,932.72
| Professional | | $256.79 | $503.79 | $3,932.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,988.97 / $2,988.97 / $3,106.54
| Professional | | $2,988.97 | $2,988.97 | $3,106.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,078.95 / $13,188.33 / $15,144.65
| Facility | | $3,078.95 | $13,188.33 | $15,144.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $220.85 / $233.62 / $1,601.94
| Professional | | $220.85 | $233.62 | $1,601.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $657.00 / $3,745.00 / $8,017.00
| Facility | | $657.00 | $3,745.00 | $8,017.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $217.50 / $622.91 / $3,957.58
| Professional | | $217.50 | $622.91 | $3,957.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.00 / $298.60 / $6,382.60
| Professional | | $5.00 | $298.60 | $6,382.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $261.14 / $517.39 / $3,932.72
| Professional | | $261.14 | $517.39 | $3,932.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $213.78 / $222.18 / $2,287.15
| Facility | | $213.78 | $222.18 | $2,287.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $213.78 / $222.30 / $2,133.28
| Professional | | $213.78 | $222.30 | $2,133.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,304.00 / $4,584.00 / $9,631.00
| Facility | | $2,304.00 | $4,584.00 | $9,631.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,294.26 / $3,120.94 / $4,676.87
| Professional | | $2,294.26 | $3,120.94 | $4,676.87 |