- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $719.07 / $6,715.08 / $8,897.77
| Facility | | $719.07 | $6,715.08 | $8,897.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $719.07 / $719.07 / $2,919.60
| Professional | | $719.07 | $719.07 | $2,919.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,157.17 / $5,080.10 / $13,868.10
| Facility | | $2,157.17 | $5,080.10 | $13,868.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,401.41 / $2,919.60 / $10,963.19
| Professional | | $1,401.41 | $2,919.60 | $10,963.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,181.10 / $6,403.90 / $11,601.28
| Facility | | $4,181.10 | $6,403.90 | $11,601.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $609.50 / $609.50 / $2,890.40
| Professional | | $609.50 | $609.50 | $2,890.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,897.74 / $2,109.50 / $5,692.08
| Facility | | $1,897.74 | $2,109.50 | $5,692.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,518.18 / $2,626.40 / $13,028.10
| Professional | | $1,518.18 | $2,626.40 | $13,028.10 |
- 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
- $4,212.85 / $4,212.85 / $4,956.30
| Professional | | $4,212.85 | $4,212.85 | $4,956.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,919.60 / $2,919.60 / $9,493.79
| Professional | | $2,919.60 | $2,919.60 | $9,493.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,277.29 / $2,277.29 / $6,333.20
| Facility | | $2,277.29 | $2,277.29 | $6,333.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,080.10 / $13,868.10 / $13,868.10
| Facility | | $5,080.10 | $13,868.10 | $13,868.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,313.82 / $1,751.76 / $14,598.00
| Professional | | $1,313.82 | $1,751.76 | $14,598.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,226.23 / $1,751.76 / $5,564.96
| Professional | | $1,226.23 | $1,751.76 | $5,564.96 |