- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $326.74 / $3,797.00 / $10,965.00
| Facility | | $326.74 | $3,797.00 | $10,965.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $253.71 / $1,215.78 / $3,072.47
| Professional | | $253.71 | $1,215.78 | $3,072.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,393.00 / $4,120.00 / $8,836.00
| Facility | | $2,393.00 | $4,120.00 | $8,836.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,220.58 / $1,631.80 / $4,532.22
| Professional | | $1,220.58 | $1,631.80 | $4,532.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $313.27 / $1,716.00 / $6,213.00
| Facility | | $313.27 | $1,716.00 | $6,213.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $313.27 / $313.27 / $3,398.56
| Professional | | $313.27 | $313.27 | $3,398.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $381.95 / $381.95 / $10,297.11
| Facility | | $381.95 | $381.95 | $10,297.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $262.05 / $1,786.42 / $7,408.58
| Professional | | $262.05 | $1,786.42 | $7,408.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $236.06 / $294.00 / $575.51
| Facility | | $236.06 | $294.00 | $575.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,367.83 / $3,028.01 / $4,551.49
| Professional | | $2,367.83 | $3,028.01 | $4,551.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $909.36 / $2,573.46 / $4,238.66
| Professional | | $909.36 | $2,573.46 | $4,238.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $381.95 / $555.00 / $10,297.11
| Facility | | $381.95 | $555.00 | $10,297.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $284.45 / $2,442.02 / $6,086.97
| Professional | | $284.45 | $2,442.02 | $6,086.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,768.00 / $4,176.00 / $8,312.00
| Facility | | $1,768.00 | $4,176.00 | $8,312.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,850.20 / $2,561.94 / $5,864.16
| Professional | | $1,850.20 | $2,561.94 | $5,864.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $288.44 / $288.44 / $772.83
| Facility | | $288.44 | $288.44 | $772.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $772.83 / $2,573.46 / $4,238.66
| Professional | | $772.83 | $2,573.46 | $4,238.66 |