- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $815.16 / $2,663.12 / $3,625.00
| Facility | | $815.16 | $2,663.12 | $3,625.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $216.28 / $673.51 / $1,471.06
| Professional | | $216.28 | $673.51 | $1,471.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $481.08 / $1,790.00 / $4,142.00
| Facility | | $481.08 | $1,790.00 | $4,142.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $258.76 / $1,668.95 / $7,125.20
| Professional | | $258.76 | $1,668.95 | $7,125.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $237.00 / $300.75 / $543.67
| Facility | | $237.00 | $300.75 | $543.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $332.27 / $1,236.29 / $2,219.02
| Professional | | $332.27 | $1,236.29 | $2,219.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $262.16 / $578.79 / $2,780.17
| Professional | | $262.16 | $578.79 | $2,780.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $204.19 / $306.80 / $6,679.00
| Facility | | $204.19 | $306.80 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,160.96 / $1,520.12 / $2,622.91
| Professional | | $1,160.96 | $1,520.12 | $2,622.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $295.81 / $1,037.86 / $2,805.90
| Professional | | $295.81 | $1,037.86 | $2,805.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,271.79 / $2,271.79 / $2,271.79
| Facility | | $2,271.79 | $2,271.79 | $2,271.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $159.09 / $265.81 / $319.77
| Professional | | $159.09 | $265.81 | $319.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $736.00 / $1,835.31 / $7,231.00
| Facility | | $736.00 | $1,835.31 | $7,231.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,108.67 / $2,672.79 / $7,125.20
| Professional | | $1,108.67 | $2,672.79 | $7,125.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $627.00 / $1,818.00 / $2,733.00
| Facility | | $627.00 | $1,818.00 | $2,733.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.50 / $1,703.38 / $3,149.55
| Professional | | $346.50 | $1,703.38 | $3,149.55 |