- 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
- $561.88 / $594.50 / $971.04
| Professional | | $561.88 | $594.50 | $971.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,313.00 / $3,997.00 / $12,379.00
| Facility | | $1,313.00 | $3,997.00 | $12,379.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $572.79 / $1,161.64 / $4,407.12
| Professional | | $572.79 | $1,161.64 | $4,407.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $857.08 / $1,180.05 / $1,925.01
| Professional | | $857.08 | $1,180.05 | $1,925.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $719.07 / $1,260.49 / $2,324.27
| Professional | | $719.07 | $1,260.49 | $2,324.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $608.03 / $1,312.16 / $6,679.00
| Facility | | $608.03 | $1,312.16 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $376.46 / $697.71 / $1,124.70
| Professional | | $376.46 | $697.71 | $1,124.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $756.12 / $1,508.01 / $2,215.82
| Professional | | $756.12 | $1,508.01 | $2,215.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,115.38 / $4,115.38 / $4,115.38
| Facility | | $4,115.38 | $4,115.38 | $4,115.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $178.88 / $178.88 / $178.88
| Professional | | $178.88 | $178.88 | $178.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,902.00 / $4,525.00 / $26,542.00
| Facility | | $1,902.00 | $4,525.00 | $26,542.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $673.11 / $1,188.24 / $4,407.12
| Professional | | $673.11 | $1,188.24 | $4,407.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,902.00 / $3,764.00 / $8,766.00
| Facility | | $1,902.00 | $3,764.00 | $8,766.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $533.48 / $861.58 / $1,839.09
| Professional | | $533.48 | $861.58 | $1,839.09 |