- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,285.36 / $3,339.00 / $5,883.00
| Facility | | $1,285.36 | $3,339.00 | $5,883.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $195.31 / $1,285.36 / $2,770.21
| Professional | | $195.31 | $1,285.36 | $2,770.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $598.07 / $3,245.00 / $7,608.00
| Facility | | $598.07 | $3,245.00 | $7,608.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $288.38 / $2,379.96 / $6,973.65
| Professional | | $288.38 | $2,379.96 | $6,973.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $311.08 / $404.40 / $793.25
| Facility | | $311.08 | $404.40 | $793.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $474.63 / $1,421.79 / $5,135.55
| Professional | | $474.63 | $1,421.79 | $5,135.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $214.32 / $402.67 / $6,679.00
| Facility | | $214.32 | $402.67 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,718.85 / $2,023.33 / $3,617.57
| Professional | | $1,718.85 | $2,023.33 | $3,617.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $339.15 / $1,684.68 / $4,195.85
| Professional | | $339.15 | $1,684.68 | $4,195.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $4,287.00 / $9,401.00
| Facility | | $55.00 | $4,287.00 | $9,401.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,344.78 / $4,374.06 / $13,893.51
| Professional | | $2,344.78 | $4,374.06 | $13,893.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,850.00 / $5,572.00 / $11,272.00
| Facility | | $1,850.00 | $5,572.00 | $11,272.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,154.69 / $3,368.16 / $6,838.58
| Professional | | $2,154.69 | $3,368.16 | $6,838.58 |