- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,924.00 / $2,747.00 / $5,039.00
| Facility | | $1,924.00 | $2,747.00 | $5,039.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $535.27 / $635.22 / $1,532.61
| Professional | | $535.27 | $635.22 | $1,532.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,434.59 / $5,508.58 / $14,018.00
| Facility | | $1,434.59 | $5,508.58 | $14,018.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $623.37 / $1,063.11 / $4,633.92
| Professional | | $623.37 | $1,063.11 | $4,633.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $846.64 / $1,255.27 / $1,700.56
| Professional | | $846.64 | $1,255.27 | $1,700.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $641.19 / $1,002.89 / $1,801.25
| Professional | | $641.19 | $1,002.89 | $1,801.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $642.76 / $1,395.82 / $6,679.00
| Facility | | $642.76 | $1,395.82 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $737.57 / $893.44 / $1,228.32
| Professional | | $737.57 | $893.44 | $1,228.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $794.62 / $1,575.25 / $2,078.01
| Professional | | $794.62 | $1,575.25 | $2,078.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,784.74 / $4,784.74 / $5,837.34
| Facility | | $4,784.74 | $4,784.74 | $5,837.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $959.15 / $959.15 / $959.15
| Professional | | $959.15 | $959.15 | $959.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,377.16 / $6,078.00 / $26,542.00
| Facility | | $2,377.16 | $6,078.00 | $26,542.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $678.32 / $1,175.53 / $4,633.92
| Professional | | $678.32 | $1,175.53 | $4,633.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,386.00 / $5,904.00 / $13,017.00
| Facility | | $2,386.00 | $5,904.00 | $13,017.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $647.09 / $977.07 / $2,016.75
| Professional | | $647.09 | $977.07 | $2,016.75 |