- 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
- $882.87 / $968.05 / $1,402.24
| Professional | | $882.87 | $968.05 | $1,402.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,222.76 / $3,715.00 / $11,879.05
| Facility | | $1,222.76 | $3,715.00 | $11,879.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $756.91 / $1,237.83 / $6,322.88
| Professional | | $756.91 | $1,237.83 | $6,322.88 |
- 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
- $797.62 / $1,563.58 / $2,847.43
| Professional | | $797.62 | $1,563.58 | $2,847.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $870.31 / $1,891.82 / $6,679.00
| Facility | | $870.31 | $1,891.82 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $961.69 / $1,206.04 / $1,664.80
| Professional | | $961.69 | $1,206.04 | $1,664.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,064.96 / $2,144.83 / $6,477.00
| Professional | | $1,064.96 | $2,144.83 | $6,477.00 |
- 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
- $852.68 / $1,247.65 / $6,322.88
| Professional | | $852.68 | $1,247.65 | $6,322.88 |
- 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
- $850.21 / $1,139.01 / $2,592.26
| Professional | | $850.21 | $1,139.01 | $2,592.26 |