- 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
- $705.65 / $793.93 / $1,368.03
| Professional | | $705.65 | $793.93 | $1,368.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,485.00 / $4,402.00 / $9,401.00
| Facility | | $1,485.00 | $4,402.00 | $9,401.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $757.86 / $1,304.24 / $5,654.32
| Professional | | $757.86 | $1,304.24 | $5,654.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,027.06 / $1,522.86 / $2,062.94
| Professional | | $1,027.06 | $1,522.86 | $2,062.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $767.81 / $1,247.45 / $2,251.46
| Professional | | $767.81 | $1,247.45 | $2,251.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $783.28 / $1,349.66 / $6,679.00
| Facility | | $783.28 | $1,349.66 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $898.81 / $1,088.76 / $1,490.07
| Professional | | $898.81 | $1,088.76 | $1,490.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $975.26 / $1,933.36 / $2,550.40
| Professional | | $975.26 | $1,933.36 | $2,550.40 |
- 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
- $814.54 / $1,443.13 / $5,654.32
| Professional | | $814.54 | $1,443.13 | $5,654.32 |
- 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
- $767.82 / $1,185.28 / $2,589.39
| Professional | | $767.82 | $1,185.28 | $2,589.39 |