- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $520.10 / $5,368.66 / $11,355.95
| Facility | | $520.10 | $5,368.66 | $11,355.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $427.14 / $3,226.00 / $7,423.14
| Professional | | $427.14 | $3,226.00 | $7,423.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,266.00 / $8,669.00 / $11,373.00
| Facility | | $6,266.00 | $8,669.00 | $11,373.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $402.81 / $1,417.71 / $5,971.75
| Professional | | $402.81 | $1,417.71 | $5,971.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $451.72 / $609.78 / $15,962.00
| Professional | | $451.72 | $609.78 | $15,962.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $471.59 / $1,212.55 / $7,778.95
| Professional | | $471.59 | $1,212.55 | $7,778.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,126.52 / $4,964.74 / $6,205.93
| Professional | | $4,126.52 | $4,964.74 | $6,205.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $515.36 / $4,126.52 / $7,818.38
| Facility | | $515.36 | $4,126.52 | $7,818.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,323.96 / $5,930.00 / $8,434.00
| Professional | | $1,323.96 | $5,930.00 | $8,434.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $445.51 / $598.09 / $13,902.00
| Facility | | $445.51 | $598.09 | $13,902.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,540.21 / $6,129.28 / $16,786.00
| Professional | | $4,540.21 | $6,129.28 | $16,786.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,301.00 / $20,974.00 / $40,876.00
| Facility | | $12,301.00 | $20,974.00 | $40,876.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,415.38 / $6,847.67 / $10,216.66
| Professional | | $4,415.38 | $6,847.67 | $10,216.66 |