- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,197.42 / $2,663.12 / $3,625.00
| Facility | | $1,197.42 | $2,663.12 | $3,625.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $105.40 / $1,197.42 / $2,621.23
| Professional | | $105.40 | $1,197.42 | $2,621.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $253.19 / $2,338.00 / $4,952.00
| Facility | | $253.19 | $2,338.00 | $4,952.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $122.29 / $2,108.57 / $5,448.01
| Professional | | $122.29 | $2,108.57 | $5,448.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $132.15 / $171.80 / $336.98
| Facility | | $132.15 | $171.80 | $336.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $186.66 / $1,535.32 / $2,814.86
| Professional | | $186.66 | $1,535.32 | $2,814.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $201.71 / $608.29 / $4,784.83
| Professional | | $201.71 | $608.29 | $4,784.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $116.23 / $214.32 / $6,679.00
| Facility | | $116.23 | $214.32 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,538.00 / $1,819.68 / $3,235.10
| Professional | | $1,538.00 | $1,819.68 | $3,235.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $145.00 / $1,498.32 / $3,593.59
| Professional | | $145.00 | $1,498.32 | $3,593.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,308.63 / $4,308.63 / $4,308.63
| Professional | | $4,308.63 | $4,308.63 | $4,308.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $2,376.00 / $8,498.00
| Facility | | $55.00 | $2,376.00 | $8,498.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,013.00 / $3,399.74 / $8,799.82
| Professional | | $2,013.00 | $3,399.74 | $8,799.82 |
- 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
- $1,959.65 / $2,650.35 / $6,222.45
| Professional | | $1,959.65 | $2,650.35 | $6,222.45 |