- 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
- $814.03 / $959.51 / $1,409.46
| Professional | | $814.03 | $959.51 | $1,409.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,672.00 / $5,009.93 / $10,138.40
| Facility | | $1,672.00 | $5,009.93 | $10,138.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $768.59 / $1,234.51 / $6,650.48
| Professional | | $768.59 | $1,234.51 | $6,650.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $692.82 / $692.82 / $2,160.52
| Professional | | $692.82 | $692.82 | $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
- $811.12 / $1,591.42 / $2,670.73
| Professional | | $811.12 | $1,591.42 | $2,670.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $921.32 / $1,909.00 / $6,679.00
| Facility | | $921.32 | $1,909.00 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,018.06 / $1,284.03 / $1,772.46
| Professional | | $1,018.06 | $1,284.03 | $1,772.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,123.11 / $2,261.96 / $6,292.69
| Professional | | $1,123.11 | $2,261.96 | $6,292.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,155.00 / $5,572.00 / $26,542.00
| Facility | | $2,155.00 | $5,572.00 | $26,542.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $846.89 / $1,234.51 / $6,650.48
| Professional | | $846.89 | $1,234.51 | $6,650.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,155.00 / $4,402.00 / $8,810.00
| Facility | | $2,155.00 | $4,402.00 | $8,810.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $846.23 / $1,110.54 / $2,782.05
| Professional | | $846.23 | $1,110.54 | $2,782.05 |