- 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
- $507.86 / $567.73 / $811.39
| Professional | | $507.86 | $567.73 | $811.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,191.83 / $4,983.00 / $10,138.40
| Facility | | $1,191.83 | $4,983.00 | $10,138.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $434.56 / $733.50 / $6,848.00
| Professional | | $434.56 | $733.50 | $6,848.00 |
- 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
- $465.85 / $882.77 / $1,636.73
| Professional | | $465.85 | $882.77 | $1,636.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $500.65 / $1,082.26 / $6,679.00
| Facility | | $500.65 | $1,082.26 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $553.22 / $689.94 / $952.39
| Professional | | $553.22 | $689.94 | $952.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $614.80 / $1,238.23 / $5,944.58
| Professional | | $614.80 | $1,238.23 | $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
- $523.32 / $757.34 / $6,848.00
| Professional | | $523.32 | $757.34 | $6,848.00 |
- 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
- $491.82 / $688.84 / $1,540.98
| Professional | | $491.82 | $688.84 | $1,540.98 |