- 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
- $428.41 / $702.14 / $1,050.21
| Professional | | $428.41 | $702.14 | $1,050.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,534.11 / $7,292.00 / $26,542.00
| Facility | | $1,534.11 | $7,292.00 | $26,542.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $598.64 / $1,021.69 / $5,296.80
| Professional | | $598.64 | $1,021.69 | $5,296.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $926.71 / $1,344.69 / $2,437.11
| Professional | | $926.71 | $1,344.69 | $2,437.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $647.34 / $1,392.44 / $6,679.00
| Facility | | $647.34 | $1,392.44 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $769.32 / $938.64 / $1,507.61
| Professional | | $769.32 | $938.64 | $1,507.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $815.10 / $1,630.20 / $2,649.08
| Professional | | $815.10 | $1,630.20 | $2,649.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,941.55 / $2,941.55 / $2,941.55
| Facility | | $2,941.55 | $2,941.55 | $2,941.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,386.00 / $7,331.00 / $26,542.00
| Facility | | $2,386.00 | $7,331.00 | $26,542.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $739.31 / $1,283.31 / $5,296.80
| Professional | | $739.31 | $1,283.31 | $5,296.80 |
- 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
- $739.31 / $1,011.04 / $2,936.35
| Professional | | $739.31 | $1,011.04 | $2,936.35 |