- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,528.00 / $2,894.00 / $6,107.00
| Facility | | $2,528.00 | $2,894.00 | $6,107.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $732.77 / $835.75 / $1,180.42
| Professional | | $732.77 | $835.75 | $1,180.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,313.00 / $3,764.00 / $9,039.00
| Facility | | $1,313.00 | $3,764.00 | $9,039.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $633.48 / $1,025.23 / $5,485.00
| Professional | | $633.48 | $1,025.23 | $5,485.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,110.56 / $1,110.56 / $1,392.16
| Professional | | $1,110.56 | $1,110.56 | $1,392.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,593.42 / $1,593.42 / $1,593.42
| Facility | | $1,593.42 | $1,593.42 | $1,593.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $670.37 / $1,349.66 / $2,387.21
| Professional | | $670.37 | $1,349.66 | $2,387.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $83.43 / $4,618.00 / $9,239.00
| Facility | | $83.43 | $4,618.00 | $9,239.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,025.64 / $1,025.64 / $1,206.64
| Professional | | $1,025.64 | $1,025.64 | $1,206.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $941.26 / $1,895.70 / $4,054.78
| Professional | | $941.26 | $1,895.70 | $4,054.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,664.45 / $7,664.45 / $7,664.45
| Facility | | $7,664.45 | $7,664.45 | $7,664.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,685.00 / $4,249.00 / $26,542.00
| Facility | | $1,685.00 | $4,249.00 | $26,542.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $680.74 / $1,088.27 / $5,485.00
| Professional | | $680.74 | $1,088.27 | $5,485.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,685.00 / $3,715.00 / $8,766.00
| Facility | | $1,685.00 | $3,715.00 | $8,766.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $663.77 / $941.26 / $2,352.53
| Professional | | $663.77 | $941.26 | $2,352.53 |