- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,758.00 / $2,671.00 / $4,712.00
| Facility | | $1,758.00 | $2,671.00 | $4,712.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $772.68 / $884.54 / $1,353.66
| Professional | | $772.68 | $884.54 | $1,353.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,485.00 / $4,845.96 / $15,220.00
| Facility | | $1,485.00 | $4,845.96 | $15,220.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $878.11 / $1,503.46 / $6,236.48
| Professional | | $878.11 | $1,503.46 | $6,236.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,130.52 / $1,676.26 / $2,270.75
| Professional | | $1,130.52 | $1,676.26 | $2,270.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $884.28 / $1,452.67 / $2,479.67
| Professional | | $884.28 | $1,452.67 | $2,479.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $863.26 / $1,863.80 / $6,679.00
| Facility | | $863.26 | $1,863.80 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $990.59 / $1,199.93 / $1,640.14
| Professional | | $990.59 | $1,199.93 | $1,640.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,076.43 / $2,133.91 / $2,814.97
| Professional | | $1,076.43 | $2,133.91 | $2,814.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,155.00 / $5,268.00 / $26,542.00
| Facility | | $2,155.00 | $5,268.00 | $26,542.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $947.05 / $1,586.20 / $6,236.48
| Professional | | $947.05 | $1,586.20 | $6,236.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,155.00 / $4,983.00 / $8,810.00
| Facility | | $2,155.00 | $4,983.00 | $8,810.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $942.43 / $1,447.19 / $2,890.26
| Professional | | $942.43 | $1,447.19 | $2,890.26 |