- 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
- $851.56 / $1,004.91 / $1,463.72
| Professional | | $851.56 | $1,004.91 | $1,463.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,672.00 / $5,217.47 / $10,138.40
| Facility | | $1,672.00 | $5,217.47 | $10,138.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $824.28 / $1,283.48 / $6,925.04
| Professional | | $824.28 | $1,283.48 | $6,925.04 |
- 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
- $848.79 / $1,681.91 / $2,791.18
| Professional | | $848.79 | $1,681.91 | $2,791.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $958.59 / $1,909.00 / $6,679.00
| Facility | | $958.59 | $1,909.00 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,059.24 / $1,334.85 / $1,842.61
| Professional | | $1,059.24 | $1,334.85 | $1,842.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,169.41 / $2,355.19 / $6,292.69
| Professional | | $1,169.41 | $2,355.19 | $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
- $893.90 / $1,288.52 / $6,925.04
| Professional | | $893.90 | $1,288.52 | $6,925.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,155.00 / $5,268.00 / $9,401.00
| Facility | | $2,155.00 | $5,268.00 | $9,401.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $883.97 / $1,246.96 / $2,789.54
| Professional | | $883.97 | $1,246.96 | $2,789.54 |