- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $988.00 / $2,173.00 / $4,236.39
| Facility | | $988.00 | $2,173.00 | $4,236.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $177.24 / $3,520.57 / $7,307.37
| Professional | | $177.24 | $3,520.57 | $7,307.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $359.27 / $4,254.00 / $13,017.00
| Facility | | $359.27 | $4,254.00 | $13,017.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $183.94 / $4,785.91 / $14,153.30
| Professional | | $183.94 | $4,785.91 | $14,153.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $188.63 / $245.22 / $481.95
| Facility | | $188.63 | $245.22 | $481.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $188.26 / $376.51 / $6,893.47
| Professional | | $188.26 | $376.51 | $6,893.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.39 / $857.69 / $10,397.66
| Professional | | $245.39 | $857.69 | $10,397.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $164.86 / $257.97 / $6,679.00
| Facility | | $164.86 | $257.97 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,788.16 / $3,451.15 / $5,180.22
| Professional | | $1,788.16 | $3,451.15 | $5,180.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $206.14 / $3,350.12 / $7,420.52
| Professional | | $206.14 | $3,350.12 | $7,420.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,775.87 / $6,347.03 / $10,797.96
| Facility | | $2,775.87 | $6,347.03 | $10,797.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $239.50 / $259.16 / $513.00
| Professional | | $239.50 | $259.16 | $513.00 |
- 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
- $4,350.96 / $7,906.16 / $19,541.36
| Professional | | $4,350.96 | $7,906.16 | $19,541.36 |
- 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
- $3,771.65 / $6,098.66 / $12,274.48
| Professional | | $3,771.65 | $6,098.66 | $12,274.48 |