- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $613.59 / $6,689.83 / $10,637.11
| Facility | | $613.59 | $6,689.83 | $10,637.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $258.38 / $741.06 / $3,206.58
| Professional | | $258.38 | $741.06 | $3,206.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,153.00 / $7,363.00 / $9,410.00
| Facility | | $6,153.00 | $7,363.00 | $9,410.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $242.55 / $1,083.51 / $2,850.63
| Professional | | $242.55 | $1,083.51 | $2,850.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $270.27 / $449.63 / $5,895.00
| Professional | | $270.27 | $449.63 | $5,895.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $289.16 / $771.86 / $3,682.10
| Professional | | $289.16 | $771.86 | $3,682.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,875.98 / $2,255.92 / $2,819.91
| Professional | | $1,875.98 | $2,255.92 | $2,819.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $276.44 / $1,739.86 / $3,320.91
| Facility | | $276.44 | $1,739.86 | $3,320.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,956.00 / $2,305.00 / $3,894.00
| Professional | | $1,956.00 | $2,305.00 | $3,894.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $280.67 / $424.93 / $5,122.00
| Facility | | $280.67 | $424.93 | $5,122.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,761.19 / $2,713.20 / $6,112.00
| Professional | | $1,761.19 | $2,713.20 | $6,112.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,303.00 / $9,373.00 / $17,192.00
| Facility | | $6,303.00 | $9,373.00 | $17,192.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,590.54 / $2,695.32 / $4,263.04
| Professional | | $1,590.54 | $2,695.32 | $4,263.04 |