- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,724.82 / $2,663.12 / $4,410.00
| Facility | | $1,724.82 | $2,663.12 | $4,410.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $125.75 / $1,520.17 / $4,179.58
| Professional | | $125.75 | $1,520.17 | $4,179.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $347.89 / $3,715.00 / $11,217.00
| Facility | | $347.89 | $3,715.00 | $11,217.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $180.47 / $3,621.36 / $19,319.00
| Professional | | $180.47 | $3,621.36 | $19,319.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $166.18 / $216.03 / $423.76
| Facility | | $166.18 | $216.03 | $423.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $272.52 / $272.52 / $3,218.48
| Professional | | $272.52 | $272.52 | $3,218.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $226.65 / $649.66 / $5,871.27
| Professional | | $226.65 | $649.66 | $5,871.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $144.53 / $227.25 / $6,679.00
| Facility | | $144.53 | $227.25 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,828.45 / $2,326.10 / $4,130.93
| Professional | | $1,828.45 | $2,326.10 | $4,130.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $181.37 / $1,909.56 / $4,239.41
| Professional | | $181.37 | $1,909.56 | $4,239.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,902.00 / $3,997.00 / $9,039.00
| Facility | | $1,902.00 | $3,997.00 | $9,039.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,578.69 / $6,218.98 / $19,319.00
| Professional | | $2,578.69 | $6,218.98 | $19,319.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,902.00 / $3,764.00 / $8,766.00
| Facility | | $1,902.00 | $3,764.00 | $8,766.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,293.63 / $4,440.39 / $7,167.84
| Professional | | $2,293.63 | $4,440.39 | $7,167.84 |