- 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
- $533.91 / $626.52 / $1,024.76
| Professional | | $533.91 | $626.52 | $1,024.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,417.52 / $5,508.58 / $14,018.00
| Facility | | $1,417.52 | $5,508.58 | $14,018.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $643.17 / $1,088.92 / $4,551.04
| Professional | | $643.17 | $1,088.92 | $4,551.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $831.23 / $1,232.41 / $1,669.59
| Professional | | $831.23 | $1,232.41 | $1,669.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $648.52 / $1,024.66 / $1,798.19
| Professional | | $648.52 | $1,024.66 | $1,798.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $632.22 / $1,370.40 / $6,679.00
| Facility | | $632.22 | $1,370.40 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $725.47 / $878.79 / $1,205.95
| Professional | | $725.47 | $878.79 | $1,205.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $785.61 / $1,557.39 / $2,054.44
| Professional | | $785.61 | $1,557.39 | $2,054.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,355.48 / $6,078.00 / $26,542.00
| Facility | | $2,355.48 | $6,078.00 | $26,542.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $685.47 / $1,160.93 / $4,551.04
| Professional | | $685.47 | $1,160.93 | $4,551.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,386.00 / $5,904.00 / $13,017.00
| Facility | | $2,386.00 | $5,904.00 | $13,017.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $683.69 / $1,048.35 / $2,079.54
| Professional | | $683.69 | $1,048.35 | $2,079.54 |