- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,528.00 / $2,894.76 / $6,117.00
| Facility | | $2,528.00 | $2,894.76 | $6,117.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $383.36 / $490.51 / $840.03
| Professional | | $383.36 | $490.51 | $840.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,214.15 / $3,997.00 / $12,379.00
| Facility | | $1,214.15 | $3,997.00 | $12,379.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $474.36 / $1,000.70 / $3,770.32
| Professional | | $474.36 | $1,000.70 | $3,770.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $750.39 / $1,033.16 / $1,781.15
| Professional | | $750.39 | $1,033.16 | $1,781.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $597.96 / $1,110.99 / $1,948.89
| Professional | | $597.96 | $1,110.99 | $1,948.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $529.23 / $1,148.82 / $6,679.00
| Facility | | $529.23 | $1,148.82 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $329.60 / $607.29 / $979.08
| Professional | | $329.60 | $607.29 | $979.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $663.14 / $1,322.57 / $2,024.19
| Professional | | $663.14 | $1,322.57 | $2,024.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,164.02 / $4,164.02 / $4,164.02
| Facility | | $4,164.02 | $4,164.02 | $4,164.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,902.00 / $4,525.00 / $26,542.00
| Facility | | $1,902.00 | $4,525.00 | $26,542.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $552.02 / $1,123.06 / $3,770.32
| Professional | | $552.02 | $1,123.06 | $3,770.32 |
- 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
- $545.01 / $739.78 / $1,579.67
| Professional | | $545.01 | $739.78 | $1,579.67 |