- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $714.00 / $2,317.00 / $7,542.00
| Facility | | $714.00 | $2,317.00 | $7,542.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $224.97 / $1,099.26 / $1,191.00
| Professional | | $224.97 | $1,099.26 | $1,191.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,081.04 / $1,945.87 / $9,033.17
| Facility | | $1,081.04 | $1,945.87 | $9,033.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $167.06 / $167.06 / $167.06
| Professional | | $167.06 | $167.06 | $167.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $80.00 / $80.00 / $80.00
| Facility | | $80.00 | $80.00 | $80.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,613.67 / $1,613.67 / $1,613.67
| Facility | | $1,613.67 | $1,613.67 | $1,613.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,763.38 / $6,763.38 / $6,763.38
| Professional | | $6,763.38 | $6,763.38 | $6,763.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,618.62 / $4,566.17 / $7,159.39
| Facility | | $3,618.62 | $4,566.17 | $7,159.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8,918.24 / $10,263.44 / $12,296.63
| Professional | | $8,918.24 | $10,263.44 | $12,296.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $595.10 / $943.58 / $2,330.42
| Facility | | $595.10 | $943.58 | $2,330.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $594.51 / $594.51 / $1,715.91
| Professional | | $594.51 | $594.51 | $1,715.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $616.52 / $1,099.26 / $2,330.42
| Facility | | $616.52 | $1,099.26 | $2,330.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,532.05 / $1,715.91 / $16,484.96
| Professional | | $1,532.05 | $1,715.91 | $16,484.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $432.00 / $2,064.00 / $8,759.00
| Facility | | $432.00 | $2,064.00 | $8,759.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $921.19 / $1,264.01 / $1,996.31
| Professional | | $921.19 | $1,264.01 | $1,996.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $479.30 / $594.51 / $815.49
| Professional | | $479.30 | $594.51 | $815.49 |