- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,758.00 / $2,733.00 / $4,712.00
| Facility | | $1,758.00 | $2,733.00 | $4,712.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $383.47 / $773.91 / $868.73
| Professional | | $383.47 | $773.91 | $868.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,939.00 / $5,097.00 / $12,850.00
| Facility | | $1,939.00 | $5,097.00 | $12,850.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $840.24 / $1,196.14 / $3,140.59
| Professional | | $840.24 | $1,196.14 | $3,140.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,182.46 / $1,560.03 / $2,061.89
| Professional | | $1,182.46 | $1,560.03 | $2,061.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,114.99 / $5,114.99 / $5,114.99
| Facility | | $5,114.99 | $5,114.99 | $5,114.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $300.00 / $1,359.26 / $8,090.00
| Facility | | $300.00 | $1,359.26 | $8,090.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $943.45 / $1,155.36 / $1,594.86
| Professional | | $943.45 | $1,155.36 | $1,594.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $977.31 / $1,968.30 / $7,699.14
| Professional | | $977.31 | $1,968.30 | $7,699.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,950.00 / $2,950.00 / $2,950.00
| Facility | | $2,950.00 | $2,950.00 | $2,950.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $903.20 / $1,130.96 / $1,282.54
| Professional | | $903.20 | $1,130.96 | $1,282.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,324.00 / $5,063.00 / $16,742.00
| Facility | | $2,324.00 | $5,063.00 | $16,742.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $823.78 / $1,133.74 / $5,647.68
| Professional | | $823.78 | $1,133.74 | $5,647.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,324.00 / $5,063.00 / $10,764.00
| Facility | | $2,324.00 | $5,063.00 | $10,764.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $817.69 / $1,081.42 / $2,347.03
| Professional | | $817.69 | $1,081.42 | $2,347.03 |