- 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
- $754.06 / $837.89 / $1,203.65
| Professional | | $754.06 | $837.89 | $1,203.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,313.00 / $3,764.00 / $9,039.00
| Facility | | $1,313.00 | $3,764.00 | $9,039.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $645.07 / $1,053.44 / $5,413.04
| Professional | | $645.07 | $1,053.44 | $5,413.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $855.84 / $855.84 / $1,392.16
| Professional | | $855.84 | $855.84 | $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
- $679.35 / $1,324.57 / $2,429.08
| Professional | | $679.35 | $1,324.57 | $2,429.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $740.96 / $1,602.62 / $6,679.00
| Facility | | $740.96 | $1,602.62 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $818.76 / $1,021.67 / $1,410.31
| Professional | | $818.76 | $1,021.67 | $1,410.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $909.72 / $1,832.18 / $4,172.22
| Professional | | $909.72 | $1,832.18 | $4,172.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,685.00 / $4,249.00 / $26,542.00
| Facility | | $1,685.00 | $4,249.00 | $26,542.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $727.51 / $1,072.66 / $5,413.04
| Professional | | $727.51 | $1,072.66 | $5,413.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,685.00 / $3,997.00 / $9,039.00
| Facility | | $1,685.00 | $3,997.00 | $9,039.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $727.51 / $970.80 / $2,290.63
| Professional | | $727.51 | $970.80 | $2,290.63 |