- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $229.09 / $1,000.00 / $3,090.30
| Facility | | $229.09 | $1,000.00 | $3,090.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $181.97 / $660.69 / $1,862.09
| Professional | | $181.97 | $660.69 | $1,862.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,011.87 / $7,943.28 / $12,589.25
| Facility | | $5,011.87 | $7,943.28 | $12,589.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $309.03 / $1,000.00 / $3,311.31
| Professional | | $309.03 | $1,000.00 | $3,311.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,089.30 / $2,398.83 / $3,890.45
| Facility | | $2,089.30 | $2,398.83 | $3,890.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $338.84 / $645.65 / $2,754.23
| Professional | | $338.84 | $645.65 | $2,754.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $218.78 / $1,445.44 / $4,265.80
| Facility | | $218.78 | $1,445.44 | $4,265.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $426.58 / $602.56 / $2,187.76
| Professional | | $426.58 | $602.56 | $2,187.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $208.93 / $3,981.07 / $11,481.54
| Facility | | $208.93 | $3,981.07 | $11,481.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $912.01 / $1,698.24 / $4,570.88
| Professional | | $912.01 | $1,698.24 | $4,570.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $50.12 / $1,023.29
| Professional | | $32.36 | $50.12 | $1,023.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $380.19 / $831.76 / $2,630.27
| Professional | | $380.19 | $831.76 | $2,630.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,762.47 / $11,481.54 / $11,481.54
| Facility | | $7,762.47 | $11,481.54 | $11,481.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $338.84 / $3,890.45 / $5,248.07
| Professional | | $338.84 | $3,890.45 | $5,248.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $912.01 / $1,445.44 / $5,370.32
| Professional | | $912.01 | $1,445.44 | $5,370.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,606.93 / $10,232.93 / $12,589.25
| Facility | | $6,606.93 | $10,232.93 | $12,589.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $239.88 / $912.01 / $3,235.94
| Professional | | $239.88 | $912.01 | $3,235.94 |