- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,663.12 / $3,111.85 / $8,271.00
| Facility | | $2,663.12 | $3,111.85 | $8,271.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $200.65 / $839.12 / $7,355.27
| Professional | | $200.65 | $839.12 | $7,355.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $669.42 / $6,096.00 / $22,645.14
| Facility | | $669.42 | $6,096.00 | $22,645.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $322.82 / $7,021.55 / $18,603.71
| Professional | | $322.82 | $7,021.55 | $18,603.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $345.46 / $449.10 / $880.92
| Facility | | $345.46 | $449.10 | $880.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $472.59 / $1,920.38 / $8,977.14
| Professional | | $472.59 | $1,920.38 | $8,977.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $538.20 / $1,630.91 / $15,648.82
| Professional | | $538.20 | $1,630.91 | $15,648.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $214.32 / $471.77 / $6,679.00
| Facility | | $214.32 | $471.77 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,005.66 / $5,928.10 / $10,529.15
| Professional | | $5,005.66 | $5,928.10 | $10,529.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $377.65 / $4,868.51 / $12,125.51
| Professional | | $377.65 | $4,868.51 | $12,125.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $6,238.00 / $17,462.00
| Facility | | $55.00 | $6,238.00 | $17,462.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7,021.55 / $11,802.62 / $29,148.69
| Professional | | $7,021.55 | $11,802.62 | $29,148.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,485.00 / $6,474.00 / $13,737.00
| Facility | | $2,485.00 | $6,474.00 | $13,737.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,384.11 / $9,269.17 / $15,781.90
| Professional | | $6,384.11 | $9,269.17 | $15,781.90 |