- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,758.00 / $2,747.00 / $5,454.00
| Facility | | $1,758.00 | $2,747.00 | $5,454.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $459.03 / $1,857.80 / $11,116.60
| Professional | | $459.03 | $1,857.80 | $11,116.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $941.10 / $5,071.00 / $22,645.14
| Facility | | $941.10 | $5,071.00 | $22,645.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $677.76 / $9,684.29 / $25,445.28
| Professional | | $677.76 | $9,684.29 | $25,445.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $727.81 / $946.15 / $1,855.92
| Facility | | $727.81 | $946.15 | $1,855.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $996.89 / $4,758.88 / $18,901.71
| Professional | | $996.89 | $4,758.88 | $18,901.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $629.86 / $1,327.08 / $6,679.00
| Facility | | $629.86 | $1,327.08 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7,797.08 / $9,217.10 / $16,400.75
| Professional | | $7,797.08 | $9,217.10 | $16,400.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $790.12 / $7,588.66 / $18,410.83
| Professional | | $790.12 | $7,588.66 | $18,410.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,004.51 / $1,004.51 / $1,030.00
| Professional | | $1,004.51 | $1,004.51 | $1,030.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $6,238.00 / $17,462.00
| Facility | | $55.00 | $6,238.00 | $17,462.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9,513.15 / $15,752.67 / $44,498.52
| Professional | | $9,513.15 | $15,752.67 | $44,498.52 |
- 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
- $8,644.39 / $11,373.14 / $25,445.28
| Professional | | $8,644.39 | $11,373.14 | $25,445.28 |