- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,758.00 / $2,733.00 / $4,712.00
| Facility | | $1,758.00 | $2,733.00 | $4,712.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $625.97 / $732.24 / $1,183.41
| Professional | | $625.97 | $732.24 | $1,183.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $843.66 / $2,854.00 / $5,803.32
| Facility | | $843.66 | $2,854.00 | $5,803.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $809.62 / $1,425.45 / $6,723.29
| Professional | | $809.62 | $1,425.45 | $6,723.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,465.62 / $1,465.71 / $2,218.36
| Professional | | $1,465.62 | $1,465.71 | $2,218.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $737.24 / $1,200.57 / $2,172.27
| Professional | | $737.24 | $1,200.57 | $2,172.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $300.00 / $1,222.29 / $8,090.00
| Facility | | $300.00 | $1,222.29 | $8,090.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $864.56 / $1,047.27 / $1,434.15
| Professional | | $864.56 | $1,047.27 | $1,434.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $935.94 / $1,855.41 / $2,447.58
| Professional | | $935.94 | $1,855.41 | $2,447.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $997.38 / $997.38 / $997.38
| Facility | | $997.38 | $997.38 | $997.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $3,764.00 / $9,039.00
| Facility | | $55.00 | $3,764.00 | $9,039.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $802.47 / $1,380.53 / $6,723.29
| Professional | | $802.47 | $1,380.53 | $6,723.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,902.00 / $3,764.00 / $8,766.00
| Facility | | $1,902.00 | $3,764.00 | $8,766.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $769.51 / $1,135.43 / $2,198.83
| Professional | | $769.51 | $1,135.43 | $2,198.83 |