- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $817.69 / $6,072.60 / $56,671.09
| Facility | | $817.69 | $6,072.60 | $56,671.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $329.23 / $517.39 / $1,284.70
| Professional | | $329.23 | $517.39 | $1,284.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,310.00 / $2,310.00 / $2,406.86
| Facility | | $2,310.00 | $2,310.00 | $2,406.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $386.14 / $714.45 / $1,037.18
| Professional | | $386.14 | $714.45 | $1,037.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $600.36 / $788.32 / $976.61
| Professional | | $600.36 | $788.32 | $976.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $418.72 / $671.67 / $1,013.53
| Facility | | $418.72 | $671.67 | $1,013.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $555.55 / $654.28 / $1,115.91
| Professional | | $555.55 | $654.28 | $1,115.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $510.18 / $701.49 / $761.12
| Facility | | $510.18 | $701.49 | $761.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $446.94 / $744.06 / $1,308.85
| Facility | | $446.94 | $744.06 | $1,308.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $611.82 / $811.28 / $1,048.67
| Professional | | $611.82 | $811.28 | $1,048.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,607.31 / $9,198.70 / $11,120.17
| Facility | | $6,607.31 | $9,198.70 | $11,120.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $691.30 / $882.79 / $1,084.58
| Professional | | $691.30 | $882.79 | $1,084.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $467.78 / $9,074.00 / $12,113.00
| Facility | | $467.78 | $9,074.00 | $12,113.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $527.72 / $753.89 / $1,164.46
| Professional | | $527.72 | $753.89 | $1,164.46 |