- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,485.00 / $2,663.12 / $5,454.00
| Facility | | $1,485.00 | $2,663.12 | $5,454.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $805.01 / $916.66 / $1,403.00
| Professional | | $805.01 | $916.66 | $1,403.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,697.00 / $5,508.58 / $16,394.00
| Facility | | $1,697.00 | $5,508.58 | $16,394.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $909.89 / $1,544.99 / $6,471.20
| Professional | | $909.89 | $1,544.99 | $6,471.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,173.13 / $1,739.44 / $2,356.35
| Professional | | $1,173.13 | $1,739.44 | $2,356.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $914.38 / $1,499.16 / $2,574.17
| Professional | | $914.38 | $1,499.16 | $2,574.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $895.86 / $1,811.48 / $6,679.00
| Facility | | $895.86 | $1,811.48 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,028.00 / $1,245.25 / $1,701.99
| Professional | | $1,028.00 | $1,245.25 | $1,701.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,117.39 / $2,215.11 / $2,922.09
| Professional | | $1,117.39 | $2,215.11 | $2,922.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,320.31 / $4,320.31 / $4,320.31
| Facility | | $4,320.31 | $4,320.31 | $4,320.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,386.00 / $6,078.00 / $16,394.00
| Facility | | $2,386.00 | $6,078.00 | $16,394.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $981.65 / $1,645.00 / $6,471.20
| Professional | | $981.65 | $1,645.00 | $6,471.20 |
- 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
- $978.42 / $1,497.11 / $3,004.64
| Professional | | $978.42 | $1,497.11 | $3,004.64 |