- 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
- $724.91 / $1,026.85 / $3,284.47
| Professional | | $724.91 | $1,026.85 | $3,284.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $941.10 / $3,715.00 / $7,592.40
| Facility | | $941.10 | $3,715.00 | $7,592.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $951.55 / $1,691.51 / $6,258.96
| Professional | | $951.55 | $1,691.51 | $6,258.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,207.29 / $1,662.23 / $2,865.67
| Professional | | $1,207.29 | $1,662.23 | $2,865.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $966.27 / $1,773.16 / $3,269.59
| Professional | | $966.27 | $1,773.16 | $3,269.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $300.00 / $1,386.26 / $8,090.00
| Facility | | $300.00 | $1,386.26 | $8,090.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $535.15 / $996.41 / $1,606.41
| Professional | | $535.15 | $996.41 | $1,606.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,113.70 / $2,221.16 / $3,374.89
| Professional | | $1,113.70 | $2,221.16 | $3,374.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $3,997.00 / $9,039.00
| Facility | | $55.00 | $3,997.00 | $9,039.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,031.36 / $1,788.92 / $6,258.96
| Professional | | $1,031.36 | $1,788.92 | $6,258.96 |
- 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
- $1,029.51 / $1,512.10 / $2,773.78
| Professional | | $1,029.51 | $1,512.10 | $2,773.78 |