- 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
- $977.07 / $1,155.16 / $1,591.38
| Professional | | $977.07 | $1,155.16 | $1,591.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,672.00 / $5,268.00 / $10,138.40
| Facility | | $1,672.00 | $5,268.00 | $10,138.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $887.17 / $1,421.90 / $7,653.04
| Professional | | $887.17 | $1,421.90 | $7,653.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $692.82 / $692.82 / $2,160.52
| Professional | | $692.82 | $692.82 | $2,160.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,082.51 / $2,082.51 / $2,082.51
| Facility | | $2,082.51 | $2,082.51 | $2,082.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $894.16 / $1,892.11 / $3,168.59
| Professional | | $894.16 | $1,892.11 | $3,168.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,053.29 / $1,909.00 / $6,679.00
| Facility | | $1,053.29 | $1,909.00 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,163.89 / $1,459.43 / $2,014.58
| Professional | | $1,163.89 | $1,459.43 | $2,014.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,289.01 / $2,596.07 / $5,944.58
| Professional | | $1,289.01 | $2,596.07 | $5,944.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,155.00 / $5,754.90 / $26,542.00
| Facility | | $2,155.00 | $5,754.90 | $26,542.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $982.25 / $1,442.39 / $7,653.04
| Professional | | $982.25 | $1,442.39 | $7,653.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,155.00 / $5,268.00 / $9,401.00
| Facility | | $2,155.00 | $5,268.00 | $9,401.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $922.50 / $1,294.36 / $3,038.21
| Professional | | $922.50 | $1,294.36 | $3,038.21 |