- 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
- $748.85 / $882.89 / $1,312.06
| Professional | | $748.85 | $882.89 | $1,312.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,672.00 / $4,983.00 / $10,138.40
| Facility | | $1,672.00 | $4,983.00 | $10,138.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $715.05 / $1,143.38 / $6,180.56
| Professional | | $715.05 | $1,143.38 | $6,180.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $605.88 / $605.88 / $2,160.52
| Professional | | $605.88 | $605.88 | $2,160.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,082.51 / $2,082.51 / $2,082.51
| Facility | | $2,082.51 | $2,082.51 | $2,082.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $746.02 / $1,478.10 / $2,460.60
| Professional | | $746.02 | $1,478.10 | $2,460.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $856.91 / $1,811.48 / $6,679.00
| Facility | | $856.91 | $1,811.48 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $946.89 / $1,195.11 / $1,649.74
| Professional | | $946.89 | $1,195.11 | $1,649.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,044.07 / $2,102.76 / $5,944.58
| Professional | | $1,044.07 | $2,102.76 | $5,944.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,155.00 / $5,572.00 / $16,394.00
| Facility | | $2,155.00 | $5,572.00 | $16,394.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $783.77 / $1,143.38 / $6,180.56
| Professional | | $783.77 | $1,143.38 | $6,180.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,175.00 / $5,268.00 / $10,910.95
| Facility | | $2,175.00 | $5,268.00 | $10,910.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $779.97 / $1,106.50 / $2,593.73
| Professional | | $779.97 | $1,106.50 | $2,593.73 |