- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,029.98 / $2,663.12 / $3,625.00
| Facility | | $1,029.98 | $2,663.12 | $3,625.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $264.16 / $1,029.98 / $1,823.23
| Professional | | $264.16 | $1,029.98 | $1,823.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $604.62 / $3,245.00 / $7,608.00
| Facility | | $604.62 | $3,245.00 | $7,608.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $302.19 / $2,104.56 / $6,509.54
| Professional | | $302.19 | $2,104.56 | $6,509.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $279.10 / $354.18 / $640.26
| Facility | | $279.10 | $354.18 | $640.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $378.74 / $1,514.94 / $3,146.08
| Professional | | $378.74 | $1,514.94 | $3,146.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $315.26 / $712.45 / $3,635.43
| Professional | | $315.26 | $712.45 | $3,635.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $241.05 / $381.68 / $8,090.00
| Facility | | $241.05 | $381.68 | $8,090.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,422.61 / $1,862.72 / $3,214.05
| Professional | | $1,422.61 | $1,862.72 | $3,214.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.45 / $1,294.28 / $3,729.67
| Professional | | $354.45 | $1,294.28 | $3,729.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $195.45 / $364.58 / $894.00
| Professional | | $195.45 | $364.58 | $894.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,485.00 / $3,110.00 / $7,608.00
| Facility | | $1,485.00 | $3,110.00 | $7,608.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,565.08 / $3,130.40 / $8,723.92
| Professional | | $1,565.08 | $3,130.40 | $8,723.92 |
- 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
- $1,434.92 / $2,380.79 / $4,050.34
| Professional | | $1,434.92 | $2,380.79 | $4,050.34 |