- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,210.76 / $2,663.12 / $3,625.00
| Facility | | $1,210.76 | $2,663.12 | $3,625.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $209.46 / $930.65 / $5,084.97
| Professional | | $209.46 | $930.65 | $5,084.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $595.54 / $4,916.00 / $13,133.71
| Facility | | $595.54 | $4,916.00 | $13,133.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $387.18 / $4,812.41 / $14,245.85
| Professional | | $387.18 | $4,812.41 | $14,245.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $279.33 / $371.52 / $713.71
| Facility | | $279.33 | $371.52 | $713.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $458.09 / $458.09 / $5,474.61
| Professional | | $458.09 | $458.09 | $5,474.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $370.71 / $2,487.46 / $8,250.95
| Professional | | $370.71 | $2,487.46 | $8,250.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $238.71 / $382.02 / $8,090.00
| Facility | | $238.71 | $382.02 | $8,090.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,110.60 / $3,956.67 / $7,027.65
| Professional | | $3,110.60 | $3,956.67 | $7,027.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $306.06 / $2,761.61 / $7,196.42
| Professional | | $306.06 | $2,761.61 | $7,196.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $441.02 / $441.02 / $441.02
| Facility | | $441.02 | $441.02 | $441.02 |
- 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
- $1,754.24 / $5,662.02 / $18,993.91
| Professional | | $1,754.24 | $5,662.02 | $18,993.91 |
- 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
- $4,184.70 / $5,465.28 / $11,906.58
| Professional | | $4,184.70 | $5,465.28 | $11,906.58 |