- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,924.00 / $2,747.00 / $7,625.00
| Facility | | $1,924.00 | $2,747.00 | $7,625.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $681.54 / $796.07 / $2,031.25
| Professional | | $681.54 | $796.07 | $2,031.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,591.00 / $4,916.00 / $16,742.00
| Facility | | $1,591.00 | $4,916.00 | $16,742.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $798.66 / $1,389.39 / $5,617.84
| Professional | | $798.66 | $1,389.39 | $5,617.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,096.97 / $1,516.39 / $2,047.82
| Professional | | $1,096.97 | $1,516.39 | $2,047.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $795.47 / $1,346.86 / $2,208.81
| Professional | | $795.47 | $1,346.86 | $2,208.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $777.43 / $1,680.84 / $6,679.00
| Facility | | $777.43 | $1,680.84 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $892.10 / $1,080.63 / $1,479.14
| Professional | | $892.10 | $1,080.63 | $1,479.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $966.66 / $1,916.31 / $2,527.91
| Professional | | $966.66 | $1,916.31 | $2,527.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,634.49 / $7,036.71 / $14,613.84
| Facility | | $4,634.49 | $7,036.71 | $14,613.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $174.49 / $1,292.71 / $1,727.90
| Professional | | $174.49 | $1,292.71 | $1,727.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,324.00 / $5,097.00 / $26,542.00
| Facility | | $2,324.00 | $5,097.00 | $26,542.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $871.81 / $1,426.06 / $5,617.84
| Professional | | $871.81 | $1,426.06 | $5,617.84 |
- 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
- $837.75 / $1,184.07 / $2,495.85
| Professional | | $837.75 | $1,184.07 | $2,495.85 |