- 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
- $640.72 / $800.52 / $1,105.02
| Professional | | $640.72 | $800.52 | $1,105.02 |
- 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
- $585.91 / $955.44 / $4,928.39
| Professional | | $585.91 | $955.44 | $4,928.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,009.97 / $1,337.03 / $1,776.44
| Professional | | $1,009.97 | $1,337.03 | $1,776.44 |
- 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
- $628.11 / $1,205.10 / $2,206.10
| Professional | | $628.11 | $1,205.10 | $2,206.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $674.55 / $1,458.10 / $6,679.00
| Facility | | $674.55 | $1,458.10 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $745.38 / $929.54 / $1,283.13
| Professional | | $745.38 | $929.54 | $1,283.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $829.03 / $1,669.67 / $3,618.15
| Professional | | $829.03 | $1,669.67 | $3,618.15 |
- 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
- $687.74 / $973.37 / $4,928.39
| Professional | | $687.74 | $973.37 | $4,928.39 |
- 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
- $687.74 / $908.87 / $2,064.78
| Professional | | $687.74 | $908.87 | $2,064.78 |