- 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
- $685.78 / $805.61 / $1,335.17
| Professional | | $685.78 | $805.61 | $1,335.17 |
- 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
- $872.14 / $1,484.84 / $6,045.52
| Professional | | $872.14 | $1,484.84 | $6,045.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,122.05 / $1,663.69 / $2,253.73
| Professional | | $1,122.05 | $1,663.69 | $2,253.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $869.88 / $1,428.94 / $2,393.36
| Professional | | $869.88 | $1,428.94 | $2,393.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $846.02 / $1,849.86 / $6,679.00
| Facility | | $846.02 | $1,849.86 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $970.81 / $1,179.29 / $1,627.88
| Professional | | $970.81 | $1,179.29 | $1,627.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,042.43 / $2,066.51 / $2,726.06
| Professional | | $1,042.43 | $2,066.51 | $2,726.06 |
- 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
- $895.05 / $1,550.88 / $6,045.52
| Professional | | $895.05 | $1,550.88 | $6,045.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,155.00 / $5,268.00 / $10,000.29
| Facility | | $2,155.00 | $5,268.00 | $10,000.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $891.73 / $1,305.79 / $2,611.62
| Professional | | $891.73 | $1,305.79 | $2,611.62 |