- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $988.00 / $2,249.00 / $4,469.93
| Facility | | $988.00 | $2,249.00 | $4,469.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $204.34 / $2,373.01 / $5,840.99
| Professional | | $204.34 | $2,373.01 | $5,840.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $236.38 / $941.10 / $4,615.14
| Facility | | $236.38 | $941.10 | $4,615.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $237.69 / $5,108.91 / $12,671.22
| Professional | | $237.69 | $5,108.91 | $12,671.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $244.60 / $314.31 / $623.73
| Facility | | $244.60 | $314.31 | $623.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,359.71 / $1,359.71 / $19,219.16
| Professional | | $1,359.71 | $1,359.71 | $19,219.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $273.85 / $894.93 / $8,923.08
| Professional | | $273.85 | $894.93 | $8,923.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $209.84 / $315.27 / $6,679.00
| Facility | | $209.84 | $315.27 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,220.02 / $3,938.52 / $5,547.66
| Professional | | $3,220.02 | $3,938.52 | $5,547.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $285.54 / $1,682.02 / $7,451.35
| Professional | | $285.54 | $1,682.02 | $7,451.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,319.89 / $3,863.50 / $9,944.73
| Facility | | $2,319.89 | $3,863.50 | $9,944.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $312.91 / $625.82 / $989.87
| Professional | | $312.91 | $625.82 | $989.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $1,818.00 / $7,231.00
| Facility | | $55.00 | $1,818.00 | $7,231.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,497.68 / $7,752.32 / $31,785.96
| Professional | | $4,497.68 | $7,752.32 | $31,785.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $627.00 / $1,818.00 / $7,231.00
| Facility | | $627.00 | $1,818.00 | $7,231.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,809.98 / $6,606.12 / $10,908.13
| Professional | | $3,809.98 | $6,606.12 | $10,908.13 |