- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,102.03 / $2,663.12 / $4,410.00
| Facility | | $1,102.03 | $2,663.12 | $4,410.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $210.02 / $1,102.03 / $2,630.07
| Professional | | $210.02 | $1,102.03 | $2,630.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $637.66 / $3,245.00 / $7,608.00
| Facility | | $637.66 | $3,245.00 | $7,608.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $307.69 / $2,287.46 / $5,724.10
| Professional | | $307.69 | $2,287.46 | $5,724.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $329.87 / $428.83 / $841.17
| Facility | | $329.87 | $428.83 | $841.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $510.03 / $1,551.84 / $4,764.75
| Professional | | $510.03 | $1,551.84 | $4,764.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $214.32 / $428.11 / $6,679.00
| Facility | | $214.32 | $428.11 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,845.16 / $2,172.78 / $3,884.78
| Professional | | $1,845.16 | $2,172.78 | $3,884.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $360.45 / $1,808.79 / $4,504.97
| Professional | | $360.45 | $1,808.79 | $4,504.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $4,287.00 / $9,401.00
| Facility | | $55.00 | $4,287.00 | $9,401.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,273.90 / $3,568.60 / $10,546.00
| Professional | | $2,273.90 | $3,568.60 | $10,546.00 |
- 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
- $2,003.29 / $2,659.06 / $5,724.10
| Professional | | $2,003.29 | $2,659.06 | $5,724.10 |