- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,168.07 / $4,823.10 / $6,532.84
| Facility | | $1,168.07 | $4,823.10 | $6,532.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $517.89 / $517.89 / $3,301.14
| Professional | | $517.89 | $517.89 | $3,301.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,583.82 / $2,451.28 / $10,182.10
| Facility | | $1,583.82 | $2,451.28 | $10,182.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $602.10 / $1,984.91 / $8,049.28
| Professional | | $602.10 | $1,984.91 | $8,049.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $48.48 / $4,586.09 / $8,518.00
| Facility | | $48.48 | $4,586.09 | $8,518.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,014.98 / $2,014.98 / $2,122.16
| Professional | | $2,014.98 | $2,014.98 | $2,122.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $432.55 / $1,497.88 / $4,179.18
| Facility | | $432.55 | $1,497.88 | $4,179.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,114.76 / $1,928.38 / $9,565.62
| Professional | | $1,114.76 | $1,928.38 | $9,565.62 |
- 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
- $3,093.13 / $3,093.13 / $3,638.98
| Professional | | $3,093.13 | $3,093.13 | $3,638.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,143.60 / $2,143.60 / $6,638.51
| Professional | | $2,143.60 | $2,143.60 | $6,638.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,729.86 / $10,182.10 / $10,182.10
| Facility | | $3,729.86 | $10,182.10 | $10,182.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $361.26 / $1,286.16 / $10,718.00
| Professional | | $361.26 | $1,286.16 | $10,718.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $361.26 / $1,071.80 / $2,284.78
| Professional | | $361.26 | $1,071.80 | $2,284.78 |