- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,758.00 / $2,671.00 / $4,712.00
| Facility | | $1,758.00 | $2,671.00 | $4,712.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $159.03 / $1,052.80 / $3,858.41
| Professional | | $159.03 | $1,052.80 | $3,858.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $524.85 / $5,508.58 / $13,017.00
| Facility | | $524.85 | $5,508.58 | $13,017.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $226.44 / $3,382.58 / $8,623.25
| Professional | | $226.44 | $3,382.58 | $8,623.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $243.05 / $315.97 / $619.78
| Facility | | $243.05 | $315.97 | $619.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $349.75 / $2,389.42 / $4,380.78
| Professional | | $349.75 | $2,389.42 | $4,380.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $333.42 / $1,600.03 / $6,759.03
| Professional | | $333.42 | $1,600.03 | $6,759.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $209.96 / $315.45 / $6,679.00
| Facility | | $209.96 | $315.45 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,396.56 / $2,831.96 / $5,041.04
| Professional | | $2,396.56 | $2,831.96 | $5,041.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $264.60 / $2,334.71 / $5,814.85
| Professional | | $264.60 | $2,334.71 | $5,814.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,863.50 / $8,373.56 / $10,415.09
| Facility | | $3,863.50 | $8,373.56 | $10,415.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $336.41 / $344.95 / $660.84
| Professional | | $336.41 | $344.95 | $660.84 |
- 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
- $3,327.70 / $5,840.75 / $13,741.47
| Professional | | $3,327.70 | $5,840.75 | $13,741.47 |
- 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
- $3,049.80 / $4,594.02 / $8,623.25
| Professional | | $3,049.80 | $4,594.02 | $8,623.25 |