- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,497.90 / $3,339.00 / $5,970.00
| Facility | | $1,497.90 | $3,339.00 | $5,970.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $269.77 / $1,145.31 / $2,891.45
| Professional | | $269.77 | $1,145.31 | $2,891.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $818.35 / $4,671.00 / $13,017.00
| Facility | | $818.35 | $4,671.00 | $13,017.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $403.28 / $2,777.10 / $8,230.62
| Professional | | $403.28 | $2,777.10 | $8,230.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $433.23 / $563.20 / $1,104.74
| Facility | | $433.23 | $563.20 | $1,104.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $670.61 / $2,017.51 / $6,099.56
| Professional | | $670.61 | $2,017.51 | $6,099.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $373.75 / $789.94 / $6,679.00
| Facility | | $373.75 | $789.94 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,992.08 / $2,351.33 / $4,204.02
| Professional | | $1,992.08 | $2,351.33 | $4,204.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $472.27 / $1,961.57 / $4,885.49
| Professional | | $472.27 | $1,961.57 | $4,885.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $567.02 / $567.02 / $19,138.22
| Facility | | $567.02 | $567.02 | $19,138.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $599.98 / $775.13 / $778.11
| Professional | | $599.98 | $775.13 | $778.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $5,097.00 / $14,018.00
| Facility | | $55.00 | $5,097.00 | $14,018.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,743.23 / $5,063.32 / $16,091.76
| Professional | | $2,743.23 | $5,063.32 | $16,091.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,386.00 / $5,904.00 / $13,017.00
| Facility | | $2,386.00 | $5,904.00 | $13,017.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,504.01 / $3,882.93 / $6,891.84
| Professional | | $2,504.01 | $3,882.93 | $6,891.84 |