- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,575.00 / $3,363.00 / $8,083.09
| Facility | | $2,575.00 | $3,363.00 | $8,083.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $630.04 / $766.51 / $1,014.49
| Professional | | $630.04 | $766.51 | $1,014.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $941.10 / $4,006.00 / $11,879.05
| Facility | | $941.10 | $4,006.00 | $11,879.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $636.12 / $953.83 / $2,323.96
| Professional | | $636.12 | $953.83 | $2,323.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $997.52 / $1,400.30 / $2,011.80
| Professional | | $997.52 | $1,400.30 | $2,011.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,748.18 / $2,748.18 / $2,748.18
| Facility | | $2,748.18 | $2,748.18 | $2,748.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $667.57 / $1,264.55 / $2,308.73
| Professional | | $667.57 | $1,264.55 | $2,308.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $300.00 / $1,180.19 / $8,090.00
| Facility | | $300.00 | $1,180.19 | $8,090.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $818.78 / $1,003.16 / $1,384.75
| Professional | | $818.78 | $1,003.16 | $1,384.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $881.87 / $1,776.09 / $7,928.48
| Professional | | $881.87 | $1,776.09 | $7,928.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $762.11 / $762.11 / $762.11
| Professional | | $762.11 | $762.11 | $762.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $4,916.00 / $12,850.00
| Facility | | $55.00 | $4,916.00 | $12,850.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $706.64 / $989.30 / $5,096.16
| Professional | | $706.64 | $989.30 | $5,096.16 |
- 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
- $667.93 / $929.38 / $2,037.83
| Professional | | $667.93 | $929.38 | $2,037.83 |