- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $768.00 / $4,153.99 / $14,636.83
| Facility | | $768.00 | $4,153.99 | $14,636.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $438.87 / $1,112.28 / $3,732.04
| Professional | | $438.87 | $1,112.28 | $3,732.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,531.00 / $27,840.00 / $57,255.43
| Facility | | $13,531.00 | $27,840.00 | $57,255.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,190.88 / $4,350.38 / $6,686.42
| Professional | | $2,190.88 | $4,350.38 | $6,686.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $494.45 / $988.76 / $4,988.60
| Professional | | $494.45 | $988.76 | $4,988.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,079.09 / $4,079.09 / $4,201.01
| Professional | | $4,079.09 | $4,079.09 | $4,201.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,069.45 / $20,928.43 / $50,342.56
| Facility | | $6,069.45 | $20,928.43 | $50,342.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $441.71 / $467.25 / $3,802.20
| Professional | | $441.71 | $467.25 | $3,802.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $832.00 / $4,603.00 / $9,760.00
| Facility | | $832.00 | $4,603.00 | $9,760.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $438.87 / $1,225.66 / $5,337.58
| Professional | | $438.87 | $1,225.66 | $5,337.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $406.75 / $2,411.26 / $4,822.52
| Professional | | $406.75 | $2,411.26 | $4,822.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $505.96 / $1,001.63 / $4,988.60
| Professional | | $505.96 | $1,001.63 | $4,988.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $424.74 / $525.05 / $2,936.67
| Facility | | $424.74 | $525.05 | $2,936.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $424.74 / $525.05 / $2,877.95
| Professional | | $424.74 | $525.05 | $2,877.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,340.00 / $7,000.00 / $12,076.00
| Facility | | $3,340.00 | $7,000.00 | $12,076.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,834.36 / $3,616.69 / $6,443.64
| Professional | | $2,834.36 | $3,616.69 | $6,443.64 |