- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,421.00 / $2,663.12 / $3,693.00
| Facility | | $1,421.00 | $2,663.12 | $3,693.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $643.52 / $766.12 / $1,961.27
| Professional | | $643.52 | $766.12 | $1,961.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,591.00 / $4,916.00 / $15,169.65
| Facility | | $1,591.00 | $4,916.00 | $15,169.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $708.87 / $1,255.45 / $5,442.80
| Professional | | $708.87 | $1,255.45 | $5,442.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,065.34 / $1,455.89 / $1,972.23
| Professional | | $1,065.34 | $1,455.89 | $1,972.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $783.70 / $1,214.58 / $2,037.36
| Professional | | $783.70 | $1,214.58 | $2,037.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $750.30 / $1,618.78 / $6,679.00
| Facility | | $750.30 | $1,618.78 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $860.97 / $1,042.92 / $1,424.53
| Professional | | $860.97 | $1,042.92 | $1,424.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $932.66 / $1,848.91 / $2,922.61
| Professional | | $932.66 | $1,848.91 | $2,922.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,324.00 / $5,097.00 / $16,394.00
| Facility | | $2,324.00 | $5,097.00 | $16,394.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $791.70 / $1,373.15 / $5,442.80
| Professional | | $791.70 | $1,373.15 | $5,442.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,324.00 / $5,097.00 / $10,764.00
| Facility | | $2,324.00 | $5,097.00 | $10,764.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $771.60 / $1,138.08 / $2,206.28
| Professional | | $771.60 | $1,138.08 | $2,206.28 |