- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $843.55 / $2,663.12 / $3,625.00
| Facility | | $843.55 | $2,663.12 | $3,625.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $251.38 / $759.13 / $1,618.36
| Professional | | $251.38 | $759.13 | $1,618.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $607.49 / $1,790.00 / $4,142.00
| Facility | | $607.49 | $1,790.00 | $4,142.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $309.70 / $1,771.89 / $7,328.19
| Professional | | $309.70 | $1,771.89 | $7,328.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $300.01 / $380.71 / $688.22
| Facility | | $300.01 | $380.71 | $688.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $423.76 / $1,003.53 / $2,525.60
| Professional | | $423.76 | $1,003.53 | $2,525.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $327.01 / $708.19 / $2,897.86
| Professional | | $327.01 | $708.19 | $2,897.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $214.32 / $388.38 / $6,679.00
| Facility | | $214.32 | $388.38 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,191.76 / $1,557.35 / $2,692.49
| Professional | | $1,191.76 | $1,557.35 | $2,692.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $377.78 / $1,259.52 / $2,894.38
| Professional | | $377.78 | $1,259.52 | $2,894.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,410.03 / $2,410.03 / $2,410.03
| Facility | | $2,410.03 | $2,410.03 | $2,410.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $207.85 / $208.81 / $428.23
| Professional | | $207.85 | $208.81 | $428.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $736.00 / $1,802.46 / $7,231.00
| Facility | | $736.00 | $1,802.46 | $7,231.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,175.44 / $2,795.28 / $7,328.19
| Professional | | $1,175.44 | $2,795.28 | $7,328.19 |
- 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
- $391.69 / $1,801.92 / $3,271.40
| Professional | | $391.69 | $1,801.92 | $3,271.40 |