- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,066.21 / $2,822.00 / $6,117.00
| Facility | | $2,066.21 | $2,822.00 | $6,117.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $345.29 / $1,382.38 / $2,836.21
| Professional | | $345.29 | $1,382.38 | $2,836.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $783.59 / $3,895.00 / $10,174.20
| Facility | | $783.59 | $3,895.00 | $10,174.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $451.47 / $3,255.89 / $14,668.07
| Professional | | $451.47 | $3,255.89 | $14,668.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $402.14 / $522.78 / $1,027.47
| Facility | | $402.14 | $522.78 | $1,027.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $512.33 / $2,356.50 / $5,292.73
| Professional | | $512.33 | $2,356.50 | $5,292.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $442.39 / $1,557.17 / $5,331.15
| Professional | | $442.39 | $1,557.17 | $5,331.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $344.46 / $733.26 / $6,679.00
| Facility | | $344.46 | $733.26 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,033.52 / $1,993.28 / $2,994.06
| Professional | | $1,033.52 | $1,993.28 | $2,994.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $443.77 / $1,953.38 / $4,336.70
| Professional | | $443.77 | $1,953.38 | $4,336.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $4,751.20 / $12,850.00
| Facility | | $55.00 | $4,751.20 | $12,850.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,590.86 / $4,470.53 / $14,668.07
| Professional | | $2,590.86 | $4,470.53 | $14,668.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,324.00 / $5,097.00 / $10,764.00
| Facility | | $2,324.00 | $5,097.00 | $10,764.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,250.88 / $3,607.74 / $7,367.36
| Professional | | $2,250.88 | $3,607.74 | $7,367.36 |