- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,375.06 / $2,663.12 / $4,410.00
| Facility | | $1,375.06 | $2,663.12 | $4,410.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $231.16 / $647.50 / $2,183.65
| Professional | | $231.16 | $647.50 | $2,183.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $228.99 / $947.00 / $2,796.00
| Facility | | $228.99 | $947.00 | $2,796.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $231.80 / $1,965.26 / $6,464.34
| Professional | | $231.80 | $1,965.26 | $6,464.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $237.63 / $308.92 / $607.14
| Facility | | $237.63 | $308.92 | $607.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $308.62 / $1,161.82 / $4,232.42
| Professional | | $308.62 | $1,161.82 | $4,232.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $204.18 / $306.77 / $6,679.00
| Facility | | $204.18 | $306.77 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $780.65 / $1,476.14 / $2,261.51
| Professional | | $780.65 | $1,476.14 | $2,261.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $261.98 / $1,470.87 / $3,265.48
| Professional | | $261.98 | $1,470.87 | $3,265.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,182.06 / $1,182.06 / $3,740.01
| Facility | | $1,182.06 | $1,182.06 | $3,740.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $580.83 / $580.83 / $650.00
| Professional | | $580.83 | $580.83 | $650.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $1,856.00 / $3,445.00
| Facility | | $55.00 | $1,856.00 | $3,445.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,644.40 / $3,030.47 / $8,591.92
| Professional | | $1,644.40 | $3,030.47 | $8,591.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $627.00 / $1,818.00 / $2,733.00
| Facility | | $627.00 | $1,818.00 | $2,733.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,637.72 / $2,231.29 / $5,275.75
| Professional | | $1,637.72 | $2,231.29 | $5,275.75 |