- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,572.34 / $3,107.00 / $8,271.00
| Facility | | $1,572.34 | $3,107.00 | $8,271.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $314.01 / $1,024.80 / $3,069.81
| Professional | | $314.01 | $1,024.80 | $3,069.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $735.50 / $4,671.00 / $13,017.00
| Facility | | $735.50 | $4,671.00 | $13,017.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.70 / $2,862.06 / $7,326.56
| Professional | | $354.70 | $2,862.06 | $7,326.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $380.28 / $494.36 / $969.71
| Facility | | $380.28 | $494.36 | $969.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $581.83 / $2,122.78 / $4,408.38
| Professional | | $581.83 | $2,122.78 | $4,408.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $520.55 / $2,341.75 / $5,274.11
| Professional | | $520.55 | $2,341.75 | $5,274.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $328.61 / $693.40 / $6,679.00
| Facility | | $328.61 | $693.40 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,138.54 / $2,518.29 / $4,502.52
| Professional | | $2,138.54 | $2,518.29 | $4,502.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $417.79 / $2,098.38 / $5,226.22
| Professional | | $417.79 | $2,098.38 | $5,226.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,341.72 / $4,341.72 / $4,341.72
| Facility | | $4,341.72 | $4,341.72 | $4,341.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $531.34 / $531.34 / $531.34
| Professional | | $531.34 | $531.34 | $531.34 |
- 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
- $2,709.46 / $4,562.59 / $12,243.62
| Professional | | $2,709.46 | $4,562.59 | $12,243.62 |
- 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
- $2,489.01 / $3,559.64 / $7,326.56
| Professional | | $2,489.01 | $3,559.64 | $7,326.56 |