- 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
- $959.23 / $1,110.89 / $1,604.17
| Professional | | $959.23 | $1,110.89 | $1,604.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $818.35 / $2,451.79 / $6,887.55
| Facility | | $818.35 | $2,451.79 | $6,887.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $851.06 / $1,367.33 / $7,068.48
| Professional | | $851.06 | $1,367.33 | $7,068.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $692.82 / $692.82 / $1,392.16
| Professional | | $692.82 | $692.82 | $1,392.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,593.42 / $1,593.42 / $1,593.42
| Facility | | $1,593.42 | $1,593.42 | $1,593.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $904.22 / $1,738.18 / $3,116.52
| Professional | | $904.22 | $1,738.18 | $3,116.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $970.05 / $1,909.00 / $6,679.00
| Facility | | $970.05 | $1,909.00 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,071.91 / $1,340.70 / $1,850.69
| Professional | | $1,071.91 | $1,340.70 | $1,850.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,189.07 / $2,371.48 / $3,947.71
| Professional | | $1,189.07 | $2,371.48 | $3,947.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $805.78 / $805.78 / $805.78
| Professional | | $805.78 | $805.78 | $805.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $502.00 / $2,217.00 / $26,542.00
| Facility | | $502.00 | $2,217.00 | $26,542.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $950.19 / $1,384.52 / $7,068.48
| Professional | | $950.19 | $1,384.52 | $7,068.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $500.00 / $1,790.00 / $2,733.00
| Facility | | $500.00 | $1,790.00 | $2,733.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $941.00 / $1,307.26 / $2,882.14
| Professional | | $941.00 | $1,307.26 | $2,882.14 |