- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,447.39 / $1,946.08 / $2,576.28
| Professional | | $1,447.39 | $1,946.08 | $2,576.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,356.86 / $2,356.86 / $2,356.86
| Professional | | $2,356.86 | $2,356.86 | $2,356.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $274.87 / $923.56 / $1,065.20
| Facility | | $274.87 | $923.56 | $1,065.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $157.33 / $182.37 / $182.37
| Professional | | $157.33 | $182.37 | $182.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $326.95 / $326.95 / $326.95
| Professional | | $326.95 | $326.95 | $326.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,305.80 / $3,305.80 / $3,305.80
| Facility | | $3,305.80 | $3,305.80 | $3,305.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,440.00 / $1,440.00 / $3,225.16
| Facility | | $1,440.00 | $1,440.00 | $3,225.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,224.00 / $1,440.00 / $2,199.96
| Professional | | $1,224.00 | $1,440.00 | $2,199.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,265.98 / $14,832.59 / $15,373.38
| Facility | | $5,265.98 | $14,832.59 | $15,373.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $330.58 / $1,608.94 / $2,496.96
| Facility | | $330.58 | $1,608.94 | $2,496.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $304.13 / $905.03 / $2,766.61
| Professional | | $304.13 | $905.03 | $2,766.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $330.58 / $1,440.00 / $2,496.96
| Facility | | $330.58 | $1,440.00 | $2,496.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $233.64 / $1,440.00 / $1,483.20
| Professional | | $233.64 | $1,440.00 | $1,483.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,115.80 / $1,384.64 / $2,011.18
| Professional | | $1,115.80 | $1,384.64 | $2,011.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,095.82 / $2,433.71 / $2,433.71
| Professional | | $2,095.82 | $2,433.71 | $2,433.71 |