- 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
- $785.20 / $928.01 / $1,368.41
| Professional | | $785.20 | $928.01 | $1,368.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,313.00 / $3,950.84 / $9,039.00
| Facility | | $1,313.00 | $3,950.84 | $9,039.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $765.81 / $1,197.52 / $6,454.32
| Professional | | $765.81 | $1,197.52 | $6,454.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $692.82 / $692.82 / $1,316.29
| Professional | | $692.82 | $692.82 | $1,316.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,346.32 / $1,346.32 / $1,346.32
| Facility | | $1,346.32 | $1,346.32 | $1,346.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $783.21 / $1,549.69 / $2,582.48
| Professional | | $783.21 | $1,549.69 | $2,582.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $892.54 / $1,909.00 / $6,679.00
| Facility | | $892.54 | $1,909.00 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $986.26 / $1,241.98 / $1,714.42
| Professional | | $986.26 | $1,241.98 | $1,714.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,089.13 / $2,193.51 / $3,618.15
| Professional | | $1,089.13 | $2,193.51 | $3,618.15 |
- 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
- $821.98 / $1,198.10 / $6,454.32
| Professional | | $821.98 | $1,198.10 | $6,454.32 |
- 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
- $795.25 / $1,111.15 / $2,593.82
| Professional | | $795.25 | $1,111.15 | $2,593.82 |