- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,421.00 / $2,663.12 / $4,767.00
| Facility | | $1,421.00 | $2,663.12 | $4,767.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $558.25 / $677.36 / $1,379.36
| Professional | | $558.25 | $677.36 | $1,379.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,304.31 / $5,268.00 / $15,220.00
| Facility | | $1,304.31 | $5,268.00 | $15,220.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $548.10 / $1,094.32 / $4,091.04
| Professional | | $548.10 | $1,094.32 | $4,091.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $652.89 / $1,121.95 / $2,068.80
| Professional | | $652.89 | $1,121.95 | $2,068.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $556.30 / $1,190.32 / $6,679.00
| Facility | | $556.30 | $1,190.32 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $342.85 / $638.37 / $1,029.17
| Professional | | $342.85 | $638.37 | $1,029.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $691.81 / $1,379.75 / $2,082.51
| Professional | | $691.81 | $1,379.75 | $2,082.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,863.50 / $3,863.50 / $3,863.50
| Facility | | $3,863.50 | $3,863.50 | $3,863.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,052.73 / $1,052.73 / $1,052.73
| Professional | | $1,052.73 | $1,052.73 | $1,052.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,069.84 / $6,104.00 / $16,394.00
| Facility | | $2,069.84 | $6,104.00 | $16,394.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $637.91 / $1,190.32 / $4,091.04
| Professional | | $637.91 | $1,190.32 | $4,091.04 |
- 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
- $598.35 / $890.04 / $2,086.67
| Professional | | $598.35 | $890.04 | $2,086.67 |