- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,758.00 / $2,747.00 / $4,712.00
| Facility | | $1,758.00 | $2,747.00 | $4,712.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,258.59 / $2,788.49 / $6,744.39
| Professional | | $1,258.59 | $2,788.49 | $6,744.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $789.00 / $2,396.09 / $7,231.00
| Facility | | $789.00 | $2,396.09 | $7,231.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $966.20 / $1,649.42 / $15,307.50
| Professional | | $966.20 | $1,649.42 | $15,307.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,383.34 / $2,031.44 / $7,300.90
| Professional | | $1,383.34 | $2,031.44 | $7,300.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $963.77 / $1,909.00 / $6,679.00
| Facility | | $963.77 | $1,909.00 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,133.51 / $1,384.83 / $2,052.83
| Professional | | $1,133.51 | $1,384.83 | $2,052.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,199.31 / $2,275.09 / $2,987.00
| Professional | | $1,199.31 | $2,275.09 | $2,987.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,525.98 / $1,525.98 / $1,525.98
| Professional | | $1,525.98 | $1,525.98 | $1,525.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $2,854.00 / $8,068.14
| Facility | | $55.00 | $2,854.00 | $8,068.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,232.06 / $1,923.88 / $15,307.50
| Professional | | $1,232.06 | $1,923.88 | $15,307.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $953.00 / $3,325.00 / $4,662.00
| Facility | | $953.00 | $3,325.00 | $4,662.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,216.94 / $1,588.65 / $3,292.30
| Professional | | $1,216.94 | $1,588.65 | $3,292.30 |