- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,525.00 / $2,900.00 / $8,272.00
| Facility | | $1,525.00 | $2,900.00 | $8,272.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $490.37 / $1,495.20 / $9,874.71
| Professional | | $490.37 | $1,495.20 | $9,874.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $817.46 / $3,887.00 / $13,483.66
| Facility | | $817.46 | $3,887.00 | $13,483.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $562.53 / $9,281.18 / $23,009.20
| Professional | | $562.53 | $9,281.18 | $23,009.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $583.10 / $749.28 / $1,486.91
| Facility | | $583.10 | $749.28 | $1,486.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $874.65 / $3,241.39 / $14,061.83
| Professional | | $874.65 | $3,241.39 | $14,061.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $652.80 / $2,087.67 / $16,164.00
| Professional | | $652.80 | $2,087.67 | $16,164.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $497.52 / $1,063.22 / $6,679.00
| Facility | | $497.52 | $1,063.22 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,309.22 / $7,713.56 / $10,865.04
| Professional | | $6,309.22 | $7,713.56 | $10,865.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $687.10 / $5,603.98 / $14,636.94
| Professional | | $687.10 | $5,603.98 | $14,636.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,754.70 / $4,232.85 / $25,429.46
| Facility | | $3,754.70 | $4,232.85 | $25,429.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $797.00 / $1,152.82 / $1,599.00
| Professional | | $797.00 | $1,152.82 | $1,599.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $4,671.00 / $15,421.00
| Facility | | $55.00 | $4,671.00 | $15,421.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8,070.59 / $13,233.44 / $52,591.26
| Professional | | $8,070.59 | $13,233.44 | $52,591.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,386.00 / $5,904.00 / $15,421.00
| Facility | | $2,386.00 | $5,904.00 | $15,421.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7,389.34 / $11,746.61 / $19,587.48
| Professional | | $7,389.34 | $11,746.61 | $19,587.48 |