- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,758.00 / $2,733.00 / $4,806.64
| Facility | | $1,758.00 | $2,733.00 | $4,806.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $601.54 / $643.44 / $1,626.41
| Professional | | $601.54 | $643.44 | $1,626.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,313.00 / $3,997.00 / $12,379.00
| Facility | | $1,313.00 | $3,997.00 | $12,379.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $637.88 / $1,339.92 / $4,970.08
| Professional | | $637.88 | $1,339.92 | $4,970.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $338.26 / $338.26 / $1,353.07
| Professional | | $338.26 | $338.26 | $1,353.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $894.40 / $1,490.40 / $2,710.58
| Professional | | $894.40 | $1,490.40 | $2,710.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $690.19 / $1,504.46 / $6,679.00
| Facility | | $690.19 | $1,504.46 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $791.99 / $1,000.78 / $1,783.97
| Professional | | $791.99 | $1,000.78 | $1,783.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $848.28 / $1,691.81 / $2,254.73
| Professional | | $848.28 | $1,691.81 | $2,254.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,902.00 / $4,525.00 / $26,542.00
| Facility | | $1,902.00 | $4,525.00 | $26,542.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $764.91 / $1,503.75 / $4,970.08
| Professional | | $764.91 | $1,503.75 | $4,970.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,902.00 / $3,764.00 / $8,766.00
| Facility | | $1,902.00 | $3,764.00 | $8,766.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $637.88 / $1,219.10 / $2,836.01
| Professional | | $637.88 | $1,219.10 | $2,836.01 |