- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,924.00 / $2,747.00 / $5,048.00
| Facility | | $1,924.00 | $2,747.00 | $5,048.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $740.18 / $843.42 / $2,174.75
| Professional | | $740.18 | $843.42 | $2,174.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,591.00 / $4,916.00 / $16,742.00
| Facility | | $1,591.00 | $4,916.00 | $16,742.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $838.64 / $1,438.28 / $5,956.96
| Professional | | $838.64 | $1,438.28 | $5,956.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,173.07 / $1,603.10 / $2,171.65
| Professional | | $1,173.07 | $1,603.10 | $2,171.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $845.37 / $1,387.82 / $2,363.58
| Professional | | $845.37 | $1,387.82 | $2,363.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $825.11 / $1,782.48 / $6,679.00
| Facility | | $825.11 | $1,782.48 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $946.81 / $1,146.90 / $1,568.58
| Professional | | $946.81 | $1,146.90 | $1,568.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,028.51 / $2,038.92 / $2,689.66
| Professional | | $1,028.51 | $2,038.92 | $2,689.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,324.00 / $5,097.00 / $26,542.00
| Facility | | $2,324.00 | $5,097.00 | $26,542.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $901.82 / $1,514.27 / $5,956.96
| Professional | | $901.82 | $1,514.27 | $5,956.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,324.00 / $6,204.00 / $13,284.00
| Facility | | $2,324.00 | $6,204.00 | $13,284.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $898.09 / $1,331.07 / $2,770.32
| Professional | | $898.09 | $1,331.07 | $2,770.32 |