- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $0.04 / $7,423.37 / $8,258.84
| Facility | | $0.04 | $7,423.37 | $8,258.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,980.95 / $4,173.32 / $4,552.72
| Professional | | $2,980.95 | $4,173.32 | $4,552.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,167.26 / $7,537.56 / $9,901.34
| Facility | | $3,167.26 | $7,537.56 | $9,901.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,625.97 / $2,709.95 / $10,746.66
| Professional | | $1,625.97 | $2,709.95 | $10,746.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,709.95 / $3,875.23 / $6,774.88
| Facility | | $2,709.95 | $3,875.23 | $6,774.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,547.35 / $2,547.35 / $2,547.35
| Professional | | $2,547.35 | $2,547.35 | $2,547.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,743.50 / $1,958.03 / $6,165.15
| Facility | | $1,743.50 | $1,958.03 | $6,165.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,625.98 / $2,859.15 / $12,092.13
| Professional | | $1,625.98 | $2,859.15 | $12,092.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $83.43 / $4,618.00 / $9,239.00
| Facility | | $83.43 | $4,618.00 | $9,239.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,910.41 / $3,910.41 / $4,600.47
| Professional | | $3,910.41 | $3,910.41 | $4,600.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,709.95 / $2,709.95 / $8,392.44
| Professional | | $2,709.95 | $2,709.95 | $8,392.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,715.31 / $12,872.26 / $12,872.26
| Facility | | $4,715.31 | $12,872.26 | $12,872.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,625.97 / $1,625.97 / $13,549.75
| Professional | | $1,625.97 | $1,625.97 | $13,549.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,625.97 / $1,625.97 / $5,165.35
| Professional | | $1,625.97 | $1,625.97 | $5,165.35 |