- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,473.20 / $2,765.95 / $3,535.22
| Facility | | $1,473.20 | $2,765.95 | $3,535.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $306.00 / $306.00 / $1,593.02
| Professional | | $306.00 | $306.00 | $1,593.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,355.76 / $2,961.94 / $4,003.16
| Facility | | $1,355.76 | $2,961.94 | $4,003.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $696.00 / $1,160.00 / $4,600.13
| Professional | | $696.00 | $1,160.00 | $4,600.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,843.95 / $2,636.85 / $4,609.88
| Facility | | $1,843.95 | $2,636.85 | $4,609.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $700.00 / $700.00 / $700.00
| Professional | | $700.00 | $700.00 | $700.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $609.40 / $1,090.94 / $2,639.00
| Facility | | $609.40 | $1,090.94 | $2,639.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $615.29 / $1,113.56 / $3,024.00
| Professional | | $615.29 | $1,113.56 | $3,024.00 |
- 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
- $1,673.75 / $1,673.75 / $1,969.12
| Professional | | $1,673.75 | $1,673.75 | $1,969.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,160.00 / $1,160.00 / $3,592.40
| Professional | | $1,160.00 | $1,160.00 | $3,592.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,200.14 / $2,457.51 / $3,479.90
| Facility | | $1,200.14 | $2,457.51 | $3,479.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,018.40 / $5,510.00 / $5,510.00
| Facility | | $2,018.40 | $5,510.00 | $5,510.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $696.00 / $696.00 / $5,800.00
| Professional | | $696.00 | $696.00 | $5,800.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $696.00 / $696.00 / $2,071.83
| Professional | | $696.00 | $696.00 | $2,071.83 |