- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $886.00 / $2,618.00 / $3,625.00
| Facility | | $886.00 | $2,618.00 | $3,625.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $415.72 / $1,573.20 / $3,711.35
| Professional | | $415.72 | $1,573.20 | $3,711.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $894.70 / $3,715.00 / $5,714.00
| Facility | | $894.70 | $3,715.00 | $5,714.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $428.58 / $2,702.69 / $8,498.81
| Professional | | $428.58 | $2,702.69 | $8,498.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $450.70 / $599.42 / $1,151.54
| Facility | | $450.70 | $599.42 | $1,151.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $578.05 / $1,971.61 / $5,971.44
| Professional | | $578.05 | $1,971.61 | $5,971.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $382.21 / $821.80 / $6,679.00
| Facility | | $382.21 | $821.80 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,041.61 / $2,010.33 / $3,017.54
| Professional | | $1,041.61 | $2,010.33 | $3,017.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $485.34 / $1,964.03 / $4,350.33
| Professional | | $485.34 | $1,964.03 | $4,350.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,885.01 / $2,885.01 / $3,846.86
| Facility | | $2,885.01 | $2,885.01 | $3,846.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,211.00 / $1,211.00 / $1,211.00
| Professional | | $1,211.00 | $1,211.00 | $1,211.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $2,854.00 / $9,039.00
| Facility | | $55.00 | $2,854.00 | $9,039.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,317.56 / $4,297.22 / $11,479.68
| Professional | | $2,317.56 | $4,297.22 | $11,479.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,902.00 / $3,764.00 / $8,766.00
| Facility | | $1,902.00 | $3,764.00 | $8,766.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,187.44 / $2,977.76 / $6,884.23
| Professional | | $2,187.44 | $2,977.76 | $6,884.23 |