- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $987.21 / $2,466.36 / $20,680.40
| Facility | | $987.21 | $2,466.36 | $20,680.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $765.44 / $987.21 / $2,242.94
| Professional | | $765.44 | $987.21 | $2,242.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $1,214.04 / $7,292.32
| Facility | | $55.00 | $1,214.04 | $7,292.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,282.31 / $2,242.54 / $8,110.65
| Professional | | $1,282.31 | $2,242.54 | $8,110.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,077.95 / $1,843.63 / $2,701.31
| Professional | | $1,077.95 | $1,843.63 | $2,701.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,061.00 / $1,782.08 / $2,210.87
| Facility | | $1,061.00 | $1,782.08 | $2,210.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,061.00 / $1,782.08 / $2,265.51
| Professional | | $1,061.00 | $1,782.08 | $2,265.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $123.01 / $477.39 / $1,746.92
| Professional | | $123.01 | $477.39 | $1,746.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,275.49 / $1,705.15 / $1,826.42
| Facility | | $1,275.49 | $1,705.15 | $1,826.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,214.04 / $1,214.04 / $1,245.78
| Facility | | $1,214.04 | $1,214.04 | $1,245.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,309.14 / $2,078.03 / $2,555.08
| Professional | | $1,309.14 | $2,078.03 | $2,555.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,238.16 / $1,792.07 / $2,413.87
| Professional | | $1,238.16 | $1,792.07 | $2,413.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $703.00 / $2,446.00 / $36,803.00
| Facility | | $703.00 | $2,446.00 | $36,803.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,111.24 / $1,817.21 / $2,617.46
| Professional | | $1,111.24 | $1,817.21 | $2,617.46 |