- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,758.00 / $2,747.00 / $6,515.00
| Facility | | $1,758.00 | $2,747.00 | $6,515.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $678.25 / $772.32 / $1,312.71
| Professional | | $678.25 | $772.32 | $1,312.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,485.00 / $4,402.00 / $15,220.00
| Facility | | $1,485.00 | $4,402.00 | $15,220.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $730.30 / $1,263.27 / $6,095.88
| Professional | | $730.30 | $1,263.27 | $6,095.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $999.78 / $1,482.40 / $2,008.15
| Professional | | $999.78 | $1,482.40 | $2,008.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $767.61 / $1,184.33 / $2,163.27
| Professional | | $767.61 | $1,184.33 | $2,163.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $761.44 / $1,648.28 / $6,679.00
| Facility | | $761.44 | $1,648.28 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $873.75 / $1,058.40 / $1,450.49
| Professional | | $873.75 | $1,058.40 | $1,450.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $947.40 / $1,878.13 / $2,477.55
| Professional | | $947.40 | $1,878.13 | $2,477.55 |
- 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
- $788.75 / $1,396.94 / $6,095.88
| Professional | | $788.75 | $1,396.94 | $6,095.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,155.00 / $4,983.00 / $8,810.00
| Facility | | $2,155.00 | $4,983.00 | $8,810.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $745.14 / $1,142.05 / $2,359.59
| Professional | | $745.14 | $1,142.05 | $2,359.59 |