- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,421.00 / $2,663.12 / $3,693.00
| Facility | | $1,421.00 | $2,663.12 | $3,693.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $464.53 / $606.34 / $2,229.87
| Professional | | $464.53 | $606.34 | $2,229.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $941.10 / $2,871.43 / $8,498.00
| Facility | | $941.10 | $2,871.43 | $8,498.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $507.96 / $888.04 / $4,522.02
| Professional | | $507.96 | $888.04 | $4,522.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $678.52 / $1,051.99 / $1,587.26
| Professional | | $678.52 | $1,051.99 | $1,587.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $537.50 / $837.83 / $1,512.92
| Professional | | $537.50 | $837.83 | $1,512.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $537.29 / $1,166.08 / $6,679.00
| Facility | | $537.29 | $1,166.08 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $616.54 / $746.85 / $1,026.15
| Professional | | $616.54 | $746.85 | $1,026.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $665.60 / $1,319.49 / $1,740.61
| Professional | | $665.60 | $1,319.49 | $1,740.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,201.54 / $3,201.54 / $3,201.54
| Facility | | $3,201.54 | $3,201.54 | $3,201.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $544.12 / $815.47 / $923.90
| Professional | | $544.12 | $815.47 | $923.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,640.00 / $3,592.00 / $16,394.00
| Facility | | $1,640.00 | $3,592.00 | $16,394.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $538.23 / $982.57 / $4,522.02
| Professional | | $538.23 | $982.57 | $4,522.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,640.00 / $3,372.00 / $8,425.00
| Facility | | $1,640.00 | $3,372.00 | $8,425.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $538.23 / $835.18 / $2,202.55
| Professional | | $538.23 | $835.18 | $2,202.55 |