- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $993.69 / $2,663.12 / $3,625.00
| Facility | | $993.69 | $2,663.12 | $3,625.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $219.93 / $754.73 / $1,855.24
| Professional | | $219.93 | $754.73 | $1,855.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $529.49 / $1,790.00 / $4,142.00
| Facility | | $529.49 | $1,790.00 | $4,142.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $279.55 / $2,008.58 / $8,438.87
| Professional | | $279.55 | $2,008.58 | $8,438.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $259.81 / $329.70 / $596.00
| Facility | | $259.81 | $329.70 | $596.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $352.56 / $1,467.63 / $2,634.25
| Professional | | $352.56 | $1,467.63 | $2,634.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $286.62 / $617.30 / $3,392.13
| Professional | | $286.62 | $617.30 | $3,392.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $228.58 / $473.74 / $6,679.00
| Facility | | $228.58 | $473.74 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,377.17 / $1,803.23 / $3,088.38
| Professional | | $1,377.17 | $1,803.23 | $3,088.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $326.43 / $1,193.65 / $3,329.25
| Professional | | $326.43 | $1,193.65 | $3,329.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,346.29 / $2,346.29 / $2,346.29
| Facility | | $2,346.29 | $2,346.29 | $2,346.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $176.28 / $338.56 / $819.00
| Professional | | $176.28 | $338.56 | $819.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $736.00 / $2,182.75 / $7,231.00
| Facility | | $736.00 | $2,182.75 | $7,231.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,378.26 / $3,164.29 / $8,438.87
| Professional | | $1,378.26 | $3,164.29 | $8,438.87 |
- 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
- $375.73 / $2,092.48 / $3,866.53
| Professional | | $375.73 | $2,092.48 | $3,866.53 |