- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,528.00 / $2,894.76 / $6,107.00
| Facility | | $2,528.00 | $2,894.76 | $6,107.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $721.60 / $834.22 / $1,154.90
| Professional | | $721.60 | $834.22 | $1,154.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,623.54 / $4,983.00 / $10,138.40
| Facility | | $1,623.54 | $4,983.00 | $10,138.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $598.29 / $1,014.23 / $5,250.32
| Professional | | $598.29 | $1,014.23 | $5,250.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $974.02 / $974.02 / $2,160.52
| Professional | | $974.02 | $974.02 | $2,160.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,082.51 / $2,082.51 / $2,082.51
| Facility | | $2,082.51 | $2,082.51 | $2,082.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $602.10 / $1,284.75 / $2,327.87
| Professional | | $602.10 | $1,284.75 | $2,327.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $718.67 / $1,554.44 / $6,679.00
| Facility | | $718.67 | $1,554.44 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $794.13 / $990.96 / $1,367.91
| Professional | | $794.13 | $990.96 | $1,367.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $882.28 / $1,776.91 / $5,944.58
| Professional | | $882.28 | $1,776.91 | $5,944.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,155.00 / $5,572.00 / $26,542.00
| Facility | | $2,155.00 | $5,572.00 | $26,542.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $698.83 / $1,030.10 / $5,250.32
| Professional | | $698.83 | $1,030.10 | $5,250.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,155.00 / $4,402.00 / $8,810.00
| Facility | | $2,155.00 | $4,402.00 | $8,810.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $696.10 / $939.28 / $2,119.55
| Professional | | $696.10 | $939.28 | $2,119.55 |