- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,015.00 / $2,733.00 / $4,712.00
| Facility | | $1,015.00 | $2,733.00 | $4,712.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $770.30 / $895.75 / $3,007.50
| Professional | | $770.30 | $895.75 | $3,007.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,719.90 / $5,097.00 / $26,542.00
| Facility | | $1,719.90 | $5,097.00 | $26,542.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $724.85 / $1,510.55 / $5,740.48
| Professional | | $724.85 | $1,510.55 | $5,740.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,821.67 / $1,821.67 / $1,821.67
| Professional | | $1,821.67 | $1,821.67 | $1,821.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $988.35 / $1,562.71 / $2,881.55
| Professional | | $988.35 | $1,562.71 | $2,881.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $300.00 / $1,248.10 / $8,090.00
| Facility | | $300.00 | $1,248.10 | $8,090.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $479.70 / $893.17 / $1,439.97
| Professional | | $479.70 | $893.17 | $1,439.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $966.25 / $1,927.09 / $2,784.42
| Professional | | $966.25 | $1,927.09 | $2,784.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,561.12 / $3,561.12 / $3,900.96
| Facility | | $3,561.12 | $3,561.12 | $3,900.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,308.73 / $2,308.73 / $2,308.73
| Professional | | $2,308.73 | $2,308.73 | $2,308.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,324.00 / $6,280.00 / $26,542.00
| Facility | | $2,324.00 | $6,280.00 | $26,542.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $869.36 / $1,664.14 / $5,740.48
| Professional | | $869.36 | $1,664.14 | $5,740.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,324.00 / $6,204.00 / $29,715.00
| Facility | | $2,324.00 | $6,204.00 | $29,715.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $852.36 / $1,304.04 / $2,923.64
| Professional | | $852.36 | $1,304.04 | $2,923.64 |