- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,758.00 / $2,747.00 / $6,515.00
| Facility | | $1,758.00 | $2,747.00 | $6,515.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $210.24 / $802.05 / $6,815.51
| Professional | | $210.24 | $802.05 | $6,815.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $683.63 / $5,071.00 / $22,645.14
| Facility | | $683.63 | $5,071.00 | $22,645.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $312.95 / $5,025.06 / $12,145.05
| Professional | | $312.95 | $5,025.06 | $12,145.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $335.47 / $436.11 / $855.45
| Facility | | $335.47 | $436.11 | $855.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $482.74 / $1,864.84 / $7,310.14
| Professional | | $482.74 | $1,864.84 | $7,310.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $458.34 / $2,170.19 / $10,021.54
| Professional | | $458.34 | $2,170.19 | $10,021.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $295.27 / $611.70 / $6,679.00
| Facility | | $295.27 | $611.70 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,079.09 / $4,827.03 / $8,580.16
| Professional | | $4,079.09 | $4,827.03 | $8,580.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $367.82 / $3,972.30 / $9,893.41
| Professional | | $367.82 | $3,972.30 | $9,893.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,232.85 / $4,232.85 / $4,232.85
| Facility | | $4,232.85 | $4,232.85 | $4,232.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.23 / $480.35 / $608.29
| Professional | | $234.23 | $480.35 | $608.29 |
- 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
- $4,743.55 / $8,774.25 / $23,247.31
| Professional | | $4,743.55 | $8,774.25 | $23,247.31 |
- 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
- $4,486.46 / $6,503.22 / $11,437.37
| Professional | | $4,486.46 | $6,503.22 | $11,437.37 |