- 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
- $695.04 / $793.99 / $1,272.65
| Professional | | $695.04 | $793.99 | $1,272.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,485.00 / $4,402.00 / $15,220.00
| Facility | | $1,485.00 | $4,402.00 | $15,220.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $802.63 / $1,495.71 / $6,771.63
| Professional | | $802.63 | $1,495.71 | $6,771.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $847.20 / $1,376.67 / $2,218.75
| Professional | | $847.20 | $1,376.67 | $2,218.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $775.80 / $1,677.12 / $6,679.00
| Facility | | $775.80 | $1,677.12 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $890.23 / $1,078.35 / $1,475.87
| Professional | | $890.23 | $1,078.35 | $1,475.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $966.25 / $1,915.49 / $2,526.84
| Professional | | $966.25 | $1,915.49 | $2,526.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $0.82 / $0.82 / $0.82
| Facility | | $0.82 | $0.82 | $0.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,231.28 / $3,231.28 / $3,231.28
| Professional | | $3,231.28 | $3,231.28 | $3,231.28 |
- 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
- $931.20 / $1,515.49 / $6,771.63
| Professional | | $931.20 | $1,515.49 | $6,771.63 |
- 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
- $879.83 / $1,424.99 / $2,503.64
| Professional | | $879.83 | $1,424.99 | $2,503.64 |