- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,924.00 / $2,747.00 / $5,039.00
| Facility | | $1,924.00 | $2,747.00 | $5,039.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $545.04 / $662.65 / $1,365.45
| Professional | | $545.04 | $662.65 | $1,365.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,089.00 / $3,133.00 / $13,940.55
| Facility | | $1,089.00 | $3,133.00 | $13,940.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $694.25 / $1,224.89 / $4,955.76
| Professional | | $694.25 | $1,224.89 | $4,955.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,374.51 / $1,401.17 / $2,080.46
| Professional | | $1,374.51 | $1,401.17 | $2,080.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $710.28 / $1,162.92 / $1,977.86
| Professional | | $710.28 | $1,162.92 | $1,977.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $696.04 / $1,528.40 / $6,679.00
| Facility | | $696.04 | $1,528.40 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $798.71 / $974.36 / $1,344.99
| Professional | | $798.71 | $974.36 | $1,344.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $854.02 / $1,693.01 / $2,233.35
| Professional | | $854.02 | $1,693.01 | $2,233.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,640.00 / $3,592.00 / $26,542.00
| Facility | | $1,640.00 | $3,592.00 | $26,542.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $737.46 / $1,256.29 / $4,955.76
| Professional | | $737.46 | $1,256.29 | $4,955.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,640.00 / $3,372.00 / $8,425.00
| Facility | | $1,640.00 | $3,372.00 | $8,425.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $737.12 / $1,047.53 / $2,112.46
| Professional | | $737.12 | $1,047.53 | $2,112.46 |