- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,924.00 / $2,747.00 / $5,039.00
| Facility | | $1,924.00 | $2,747.00 | $5,039.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $898.87 / $1,071.07 / $1,583.16
| Professional | | $898.87 | $1,071.07 | $1,583.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,646.55 / $4,916.00 / $25,526.57
| Facility | | $1,646.55 | $4,916.00 | $25,526.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,039.02 / $1,873.86 / $7,771.25
| Professional | | $1,039.02 | $1,873.86 | $7,771.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $590.57 / $968.42 / $1,311.95
| Professional | | $590.57 | $968.42 | $1,311.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,069.34 / $1,777.75 / $2,869.79
| Professional | | $1,069.34 | $1,777.75 | $2,869.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $997.96 / $1,909.00 / $6,679.00
| Facility | | $997.96 | $1,909.00 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,145.16 / $1,387.16 / $1,895.24
| Professional | | $1,145.16 | $1,387.16 | $1,895.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,245.18 / $2,468.44 / $3,256.27
| Professional | | $1,245.18 | $2,468.44 | $3,256.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,324.00 / $5,097.00 / $26,542.00
| Facility | | $2,324.00 | $5,097.00 | $26,542.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,198.71 / $1,930.64 / $7,771.25
| Professional | | $1,198.71 | $1,930.64 | $7,771.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,324.00 / $5,097.00 / $10,764.00
| Facility | | $2,324.00 | $5,097.00 | $10,764.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,135.67 / $1,616.02 / $3,317.01
| Professional | | $1,135.67 | $1,616.02 | $3,317.01 |