- 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
- $928.16 / $1,066.92 / $1,484.23
| Professional | | $928.16 | $1,066.92 | $1,484.23 |
- 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
- $837.13 / $1,334.79 / $7,077.68
| Professional | | $837.13 | $1,334.79 | $7,077.68 |
- 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
- $839.59 / $1,745.01 / $3,013.41
| Professional | | $839.59 | $1,745.01 | $3,013.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $972.62 / $1,909.00 / $6,679.00
| Facility | | $972.62 | $1,909.00 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,074.75 / $1,345.97 / $1,857.96
| Professional | | $1,074.75 | $1,345.97 | $1,857.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,191.11 / $2,398.92 / $3,784.87
| Professional | | $1,191.11 | $2,398.92 | $3,784.87 |
- 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
- $925.16 / $1,358.33 / $7,077.68
| Professional | | $925.16 | $1,358.33 | $7,077.68 |
- 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
- $925.16 / $1,277.24 / $2,900.53
| Professional | | $925.16 | $1,277.24 | $2,900.53 |