- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,924.00 / $2,747.00 / $5,039.00
| Facility | | $1,924.00 | $2,747.00 | $5,039.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $878.23 / $1,023.39 / $1,450.75
| Professional | | $878.23 | $1,023.39 | $1,450.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,223.19 / $3,715.00 / $11,879.05
| Facility | | $1,223.19 | $3,715.00 | $11,879.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $761.15 / $1,238.82 / $6,327.84
| Professional | | $761.15 | $1,238.82 | $6,327.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $855.84 / $855.84 / $2,643.41
| Professional | | $855.84 | $855.84 | $2,643.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,748.18 / $2,748.18 / $2,748.18
| Facility | | $2,748.18 | $2,748.18 | $2,748.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $799.98 / $1,564.78 / $2,849.70
| Professional | | $799.98 | $1,564.78 | $2,849.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $870.98 / $1,893.26 / $6,679.00
| Facility | | $870.98 | $1,893.26 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $962.43 / $1,206.95 / $1,666.07
| Professional | | $962.43 | $1,206.95 | $1,666.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,065.78 / $2,146.48 / $7,273.23
| Professional | | $1,065.78 | $2,146.48 | $7,273.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,685.00 / $4,525.00 / $26,542.00
| Facility | | $1,685.00 | $4,525.00 | $26,542.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $853.37 / $1,252.23 / $6,327.84
| Professional | | $853.37 | $1,252.23 | $6,327.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,685.00 / $3,715.00 / $8,766.00
| Facility | | $1,685.00 | $3,715.00 | $8,766.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $852.56 / $1,139.44 / $2,890.37
| Professional | | $852.56 | $1,139.44 | $2,890.37 |