- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $616.60 / $2,454.71 / $16,218.10
| Facility | | $616.60 | $2,454.71 | $16,218.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $380.19 / $891.25 / $3,311.31
| Professional | | $380.19 | $891.25 | $3,311.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $380.19 / $588.84 / $2,089.30
| Professional | | $380.19 | $588.84 | $2,089.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,187.76 / $6,606.93 / $9,772.37
| Facility | | $2,187.76 | $6,606.93 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $501.19 / $1,230.27 / $13,182.57
| Professional | | $501.19 | $1,230.27 | $13,182.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $30.20 / $30.20 / $30.20
| Facility | | $30.20 | $30.20 | $30.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $436.52 / $912.01 / $3,235.94
| Professional | | $436.52 | $912.01 | $3,235.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $28,840.32 / $28,840.32 / $28,840.32
| Facility | | $28,840.32 | $28,840.32 | $28,840.32 |
- Facility/Professional
- Facility
- Modifier
- 53
- Low / Median / High Price
- $5,754.40 / $5,754.40 / $5,754.40
| Facility | 53 | $5,754.40 | $5,754.40 | $5,754.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15,848.93 / $18,620.87 / $18,620.87
| Professional | | $15,848.93 | $18,620.87 | $18,620.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,265.80 / $8,709.64 / $29,512.09
| Facility | | $4,265.80 | $8,709.64 | $29,512.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $398.11 / $1,174.90 / $2,884.03
| Professional | | $398.11 | $1,174.90 | $2,884.03 |