- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,924.00 / $2,747.00 / $5,039.00
| Facility | | $1,924.00 | $2,747.00 | $5,039.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $417.80 / $2,254.34 / $3,734.45
| Professional | | $417.80 | $2,254.34 | $3,734.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $941.10 / $3,728.00 / $9,849.00
| Facility | | $941.10 | $3,728.00 | $9,849.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $494.31 / $2,577.44 / $7,619.24
| Professional | | $494.31 | $2,577.44 | $7,619.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $527.60 / $685.88 / $1,348.02
| Facility | | $527.60 | $685.88 | $1,348.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,643.41 / $2,643.41 / $2,650.84
| Professional | | $2,643.41 | $2,643.41 | $2,650.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,911.68 / $3,911.68 / $3,911.68
| Facility | | $3,911.68 | $3,911.68 | $3,911.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $556.90 / $1,932.32 / $5,962.18
| Professional | | $556.90 | $1,932.32 | $5,962.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $442.69 / $962.02 / $6,679.00
| Facility | | $442.69 | $962.02 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,292.80 / $2,904.90 / $4,087.56
| Professional | | $2,292.80 | $2,904.90 | $4,087.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $541.90 / $2,489.96 / $6,319.52
| Professional | | $541.90 | $2,489.96 | $6,319.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $4,006.00 / $12,850.00
| Facility | | $55.00 | $4,006.00 | $12,850.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,542.67 / $3,554.42 / $14,563.92
| Professional | | $2,542.67 | $3,554.42 | $14,563.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,324.00 / $5,063.00 / $10,764.00
| Facility | | $2,324.00 | $5,063.00 | $10,764.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,436.50 / $3,483.54 / $6,511.39
| Professional | | $2,436.50 | $3,483.54 | $6,511.39 |