- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,924.00 / $2,747.00 / $5,039.00
| Facility | | $1,924.00 | $2,747.00 | $5,039.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $607.41 / $720.92 / $1,138.57
| Professional | | $607.41 | $720.92 | $1,138.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,485.00 / $4,402.00 / $9,401.00
| Facility | | $1,485.00 | $4,402.00 | $9,401.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $668.22 / $1,176.45 / $5,087.68
| Professional | | $668.22 | $1,176.45 | $5,087.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $764.51 / $1,142.59 / $1,913.53
| Professional | | $764.51 | $1,142.59 | $1,913.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $706.16 / $1,349.66 / $6,679.00
| Facility | | $706.16 | $1,349.66 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $810.32 / $981.56 / $1,345.75
| Professional | | $810.32 | $981.56 | $1,345.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $878.18 / $1,740.90 / $2,757.71
| Professional | | $878.18 | $1,740.90 | $2,757.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,483.40 / $1,483.40 / $4,701.33
| Facility | | $1,483.40 | $1,483.40 | $4,701.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $998.68 / $1,112.98 / $1,141.23
| Professional | | $998.68 | $1,112.98 | $1,141.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,155.00 / $5,268.00 / $26,542.00
| Facility | | $2,155.00 | $5,268.00 | $26,542.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $738.99 / $1,295.19 / $5,087.68
| Professional | | $738.99 | $1,295.19 | $5,087.68 |
- 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
- $723.60 / $1,070.35 / $2,173.92
| Professional | | $723.60 | $1,070.35 | $2,173.92 |