- 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
- $586.26 / $669.92 / $1,094.40
| Professional | | $586.26 | $669.92 | $1,094.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,089.00 / $3,133.00 / $8,957.00
| Facility | | $1,089.00 | $3,133.00 | $8,957.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $705.21 / $1,231.40 / $4,888.64
| Professional | | $705.21 | $1,231.40 | $4,888.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $911.07 / $1,350.87 / $1,829.96
| Professional | | $911.07 | $1,350.87 | $1,829.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $702.56 / $1,141.15 / $1,953.09
| Professional | | $702.56 | $1,141.15 | $1,953.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $684.47 / $1,502.02 / $6,679.00
| Facility | | $684.47 | $1,502.02 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $785.43 / $957.54 / $1,321.78
| Professional | | $785.43 | $957.54 | $1,321.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $838.04 / $1,661.33 / $2,191.56
| Professional | | $838.04 | $1,661.33 | $2,191.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,893.83 / $2,893.83 / $2,893.83
| Professional | | $2,893.83 | $2,893.83 | $2,893.83 |
- 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
- $752.01 / $1,276.31 / $4,888.64
| Professional | | $752.01 | $1,276.31 | $4,888.64 |
- 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
- $752.01 / $1,071.14 / $2,087.21
| Professional | | $752.01 | $1,071.14 | $2,087.21 |