- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $655.00 / $5,823.00 / $11,170.69
| Facility | | $655.00 | $5,823.00 | $11,170.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $427.15 / $2,269.83 / $6,379.75
| Professional | | $427.15 | $2,269.83 | $6,379.75 |
- 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
- $3,657.78 / $7,004.49 / $8,240.58
| Professional | | $3,657.78 | $7,004.49 | $8,240.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $473.00 / $940.26 / $7,690.56
| Professional | | $473.00 | $940.26 | $7,690.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,808.29 / $6,808.29 / $7,081.37
| Professional | | $6,808.29 | $6,808.29 | $7,081.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,940.76 / $23,954.21 / $66,156.92
| Facility | | $7,940.76 | $23,954.21 | $66,156.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $452.33 / $2,511.26 / $5,663.20
| Professional | | $452.33 | $2,511.26 | $5,663.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $768.00 / $5,188.00 / $11,892.85
| Facility | | $768.00 | $5,188.00 | $11,892.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $446.17 / $2,210.58 / $7,998.78
| Professional | | $446.17 | $2,210.58 | $7,998.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.00 / $5,182.50 / $13,508.80
| Professional | | $5.00 | $5,182.50 | $13,508.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $475.83 / $971.36 / $7,418.27
| Professional | | $475.83 | $971.36 | $7,418.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $414.19 / $503.55 / $4,728.31
| Facility | | $414.19 | $503.55 | $4,728.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $414.19 / $503.55 / $4,728.31
| Professional | | $414.19 | $503.55 | $4,728.31 |
- 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
- $4,502.72 / $5,643.40 / $9,112.14
| Professional | | $4,502.72 | $5,643.40 | $9,112.14 |