- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $918.00 / $2,954.00 / $8,017.00
| Facility | | $918.00 | $2,954.00 | $8,017.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $350.98 / $1,518.32 / $2,289.25
| Professional | | $350.98 | $1,518.32 | $2,289.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,058.35 / $6,182.00 / $17,094.48
| Facility | | $5,058.35 | $6,182.00 | $17,094.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,357.39 / $2,367.19 / $3,304.76
| Professional | | $1,357.39 | $2,367.19 | $3,304.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $404.78 / $1,547.67 / $3,148.86
| Professional | | $404.78 | $1,547.67 | $3,148.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,890.38 / $2,507.13 / $2,601.10
| Professional | | $1,890.38 | $2,507.13 | $2,601.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,335.28 / $5,148.96 / $14,067.32
| Facility | | $3,335.28 | $5,148.96 | $14,067.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $934.00 / $3,389.00 / $8,017.00
| Facility | | $934.00 | $3,389.00 | $8,017.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $369.51 / $1,518.32 / $2,828.32
| Professional | | $369.51 | $1,518.32 | $2,828.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.00 / $2,080.80 / $4,731.80
| Professional | | $5.00 | $2,080.80 | $4,731.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $414.67 / $1,608.51 / $3,247.96
| Professional | | $414.67 | $1,608.51 | $3,247.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $369.45 / $421.78 / $1,949.06
| Facility | | $369.45 | $421.78 | $1,949.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $369.45 / $1,574.92 / $1,746.17
| Professional | | $369.45 | $1,574.92 | $1,746.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,747.00 / $2,824.00 / $5,678.00
| Facility | | $1,747.00 | $2,824.00 | $5,678.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,744.72 / $2,166.82 / $3,674.95
| Professional | | $1,744.72 | $2,166.82 | $3,674.95 |