- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $270.32 / $3,955.32 / $7,049.26
| Facility | | $270.32 | $3,955.32 | $7,049.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $217.50 / $1,265.57 / $3,957.58
| Professional | | $217.50 | $1,265.57 | $3,957.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,538.00 / $9,948.00 / $15,579.70
| Facility | | $6,538.00 | $9,948.00 | $15,579.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $403.46 / $2,406.26 / $10,804.88
| Professional | | $403.46 | $2,406.26 | $10,804.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,416.63 / $6,329.76 / $10,209.68
| Facility | | $5,416.63 | $6,329.76 | $10,209.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $411.28 / $986.72 / $7,851.30
| Professional | | $411.28 | $986.72 | $7,851.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $232.10 / $460.49 / $3,779.53
| Facility | | $232.10 | $460.49 | $3,779.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $247.58 / $5,356.00 / $16,779.00
| Facility | | $247.58 | $5,356.00 | $16,779.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,790.34 / $7,334.07 / $13,710.32
| Professional | | $2,790.34 | $7,334.07 | $13,710.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $85.00 / $1,796.97 / $4,888.40
| Professional | | $85.00 | $1,796.97 | $4,888.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $232.10 / $460.49 / $3,779.53
| Facility | | $232.10 | $460.49 | $3,779.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $497.42 / $2,050.29 / $6,472.92
| Professional | | $497.42 | $2,050.29 | $6,472.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,478.83 / $3,478.83 / $3,478.83
| Facility | | $3,478.83 | $3,478.83 | $3,478.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $375.77 / $7,334.07 / $14,554.64
| Professional | | $375.77 | $7,334.07 | $14,554.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,325.87 / $10,812.23 / $13,937.46
| Professional | | $1,325.87 | $10,812.23 | $13,937.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,627.00 / $12,373.00 / $15,090.00
| Facility | | $8,627.00 | $12,373.00 | $15,090.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,620.92 / $8,281.25 / $11,900.60
| Professional | | $2,620.92 | $8,281.25 | $11,900.60 |