- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $438.89 / $4,962.67 / $15,341.00
| Facility | | $438.89 | $4,962.67 | $15,341.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $204.88 / $980.08 / $1,828.75
| Professional | | $204.88 | $980.08 | $1,828.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,901.32 / $2,901.32 / $4,375.60
| Facility | | $2,901.32 | $2,901.32 | $4,375.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $308.69 / $674.88 / $2,843.93
| Professional | | $308.69 | $674.88 | $2,843.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $373.20 / $548.32 / $2,358.44
| Professional | | $373.20 | $548.32 | $2,358.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $302.12 / $912.00 / $3,354.03
| Facility | | $302.12 | $912.00 | $3,354.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $338.13 / $1,368.26 / $2,727.31
| Professional | | $338.13 | $1,368.26 | $2,727.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $426.12 / $1,937.64 / $2,668.47
| Facility | | $426.12 | $1,937.64 | $2,668.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $302.12 / $1,284.58 / $3,394.44
| Facility | | $302.12 | $1,284.58 | $3,394.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $379.91 / $1,252.83 / $2,800.77
| Professional | | $379.91 | $1,252.83 | $2,800.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,763.99 / $12,103.13 / $13,092.93
| Facility | | $8,763.99 | $12,103.13 | $13,092.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $381.32 / $1,831.56 / $2,821.66
| Professional | | $381.32 | $1,831.56 | $2,821.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,895.00 / $11,770.00 / $26,404.00
| Facility | | $1,895.00 | $11,770.00 | $26,404.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,739.62 / $2,523.85 / $3,305.57
| Professional | | $1,739.62 | $2,523.85 | $3,305.57 |