- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $205.63 / $2,978.49 / $11,900.00
| Facility | | $205.63 | $2,978.49 | $11,900.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $204.34 / $2,346.00 / $5,546.30
| Professional | | $204.34 | $2,346.00 | $5,546.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $273.13 / $617.42 / $3,891.31
| Professional | | $273.13 | $617.42 | $3,891.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,901.02 / $9,232.96 / $14,163.61
| Facility | | $7,901.02 | $9,232.96 | $14,163.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $364.47 / $3,230.96 / $13,809.26
| Professional | | $364.47 | $3,230.96 | $13,809.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $208.00 / $822.52 / $6,314.40
| Facility | | $208.00 | $822.52 | $6,314.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $225.04 / $1,449.00 / $5,807.24
| Facility | | $225.04 | $1,449.00 | $5,807.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,381.34 / $8,462.54 / $27,435.29
| Professional | | $4,381.34 | $8,462.54 | $27,435.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $702.62 / $2,692.03 / $6,558.51
| Professional | | $702.62 | $2,692.03 | $6,558.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $208.00 / $822.52 / $6,314.40
| Facility | | $208.00 | $822.52 | $6,314.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $494.23 / $3,038.81 / $9,233.04
| Professional | | $494.23 | $3,038.81 | $9,233.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,615.14 / $4,615.14 / $4,615.14
| Facility | | $4,615.14 | $4,615.14 | $4,615.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $452.86 / $10,669.73 / $31,785.96
| Professional | | $452.86 | $10,669.73 | $31,785.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $916.53 / $12,060.28 / $18,606.88
| Professional | | $916.53 | $12,060.28 | $18,606.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,034.00 / $1,423.00 / $2,202.90
| Facility | | $1,034.00 | $1,423.00 | $2,202.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,967.16 / $8,003.43 / $17,305.12
| Professional | | $3,967.16 | $8,003.43 | $17,305.12 |