- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,646.20 / $3,339.00 / $5,883.00
| Facility | | $1,646.20 | $3,339.00 | $5,883.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $303.33 / $1,646.20 / $3,658.92
| Professional | | $303.33 | $1,646.20 | $3,658.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $818.35 / $4,671.00 / $13,017.00
| Facility | | $818.35 | $4,671.00 | $13,017.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $440.83 / $2,817.35 / $8,592.93
| Professional | | $440.83 | $2,817.35 | $8,592.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $473.37 / $615.38 / $1,207.08
| Facility | | $473.37 | $615.38 | $1,207.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $681.18 / $2,007.77 / $3,681.05
| Professional | | $681.18 | $2,007.77 | $3,681.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $731.67 / $2,297.81 / $6,187.89
| Professional | | $731.67 | $2,297.81 | $6,187.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $408.12 / $863.14 / $6,679.00
| Facility | | $408.12 | $863.14 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,022.68 / $2,389.71 / $4,272.64
| Professional | | $2,022.68 | $2,389.71 | $4,272.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $516.91 / $1,996.80 / $4,973.22
| Professional | | $516.91 | $1,996.80 | $4,973.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $328.81 / $337.16 / $883.00
| Professional | | $328.81 | $337.16 | $883.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $5,097.00 / $14,018.00
| Facility | | $55.00 | $5,097.00 | $14,018.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,743.43 / $5,169.43 / $16,544.48
| Professional | | $2,743.43 | $5,169.43 | $16,544.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,386.00 / $6,883.00 / $15,421.00
| Facility | | $2,386.00 | $6,883.00 | $15,421.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,562.67 / $3,986.95 / $6,218.28
| Professional | | $2,562.67 | $3,986.95 | $6,218.28 |