- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,661.33 / $3,111.85 / $8,331.00
| Facility | | $1,661.33 | $3,111.85 | $8,331.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $289.87 / $1,362.90 / $3,417.47
| Professional | | $289.87 | $1,362.90 | $3,417.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $818.35 / $5,071.00 / $22,645.14
| Facility | | $818.35 | $5,071.00 | $22,645.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $453.86 / $3,325.44 / $8,625.54
| Professional | | $453.86 | $3,325.44 | $8,625.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $486.93 / $633.01 / $1,241.67
| Facility | | $486.93 | $633.01 | $1,241.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $759.40 / $2,281.77 / $7,335.34
| Professional | | $759.40 | $2,281.77 | $7,335.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $420.83 / $887.88 / $6,679.00
| Facility | | $420.83 | $887.88 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,697.36 / $3,177.01 / $5,680.27
| Professional | | $2,697.36 | $3,177.01 | $5,680.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $530.42 / $2,643.15 / $6,583.03
| Professional | | $530.42 | $2,643.15 | $6,583.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,006.91 / $12,006.91 / $12,006.91
| Facility | | $12,006.91 | $12,006.91 | $12,006.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $6,003.00 / $17,462.00
| Facility | | $55.00 | $6,003.00 | $17,462.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,125.12 / $5,375.21 / $15,435.28
| Professional | | $3,125.12 | $5,375.21 | $15,435.28 |
- 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
- $2,930.31 / $3,813.16 / $8,625.54
| Professional | | $2,930.31 | $3,813.16 | $8,625.54 |