- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,528.00 / $2,894.00 / $6,107.00
| Facility | | $2,528.00 | $2,894.00 | $6,107.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $806.68 / $904.45 / $1,407.21
| Professional | | $806.68 | $904.45 | $1,407.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $991.24 / $4,254.00 / $13,940.55
| Facility | | $991.24 | $4,254.00 | $13,940.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $913.88 / $1,582.89 / $7,294.58
| Professional | | $913.88 | $1,582.89 | $7,294.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $922.14 / $1,457.40 / $2,571.56
| Professional | | $922.14 | $1,457.40 | $2,571.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $300.00 / $1,458.48 / $8,090.00
| Facility | | $300.00 | $1,458.48 | $8,090.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,032.46 / $1,250.65 / $1,711.28
| Professional | | $1,032.46 | $1,250.65 | $1,711.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,121.08 / $2,222.42 / $2,931.74
| Professional | | $1,121.08 | $2,222.42 | $2,931.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,510.75 / $3,510.75 / $3,510.75
| Facility | | $3,510.75 | $3,510.75 | $3,510.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $5,097.00 / $15,421.00
| Facility | | $55.00 | $5,097.00 | $15,421.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $976.91 / $1,651.73 / $7,294.58
| Professional | | $976.91 | $1,651.73 | $7,294.58 |
- 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
- $969.94 / $1,392.27 / $2,900.78
| Professional | | $969.94 | $1,392.27 | $2,900.78 |