- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,528.00 / $2,894.76 / $6,107.00
| Facility | | $2,528.00 | $2,894.76 | $6,107.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $618.48 / $698.67 / $1,105.46
| Professional | | $618.48 | $698.67 | $1,105.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,485.00 / $4,402.00 / $15,220.00
| Facility | | $1,485.00 | $4,402.00 | $15,220.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $699.09 / $1,197.97 / $4,962.56
| Professional | | $699.09 | $1,197.97 | $4,962.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $981.77 / $1,341.67 / $1,817.50
| Professional | | $981.77 | $1,341.67 | $1,817.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $712.45 / $1,116.52 / $1,953.94
| Professional | | $712.45 | $1,116.52 | $1,953.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $688.89 / $1,491.80 / $6,679.00
| Facility | | $688.89 | $1,491.80 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $790.50 / $957.56 / $1,312.78
| Professional | | $790.50 | $957.56 | $1,312.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $856.88 / $1,698.68 / $2,240.83
| Professional | | $856.88 | $1,698.68 | $2,240.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,438.31 / $5,438.31 / $5,438.31
| Facility | | $5,438.31 | $5,438.31 | $5,438.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,360.95 / $5,360.95 / $5,360.95
| Professional | | $5,360.95 | $5,360.95 | $5,360.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,155.00 / $5,268.00 / $26,542.00
| Facility | | $2,155.00 | $5,268.00 | $26,542.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $745.33 / $1,262.23 / $4,962.56
| Professional | | $745.33 | $1,262.23 | $4,962.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,155.00 / $4,983.00 / $8,810.00
| Facility | | $2,155.00 | $4,983.00 | $8,810.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $728.83 / $1,059.54 / $2,209.12
| Professional | | $728.83 | $1,059.54 | $2,209.12 |