- 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
- $547.83 / $609.46 / $992.48
| Professional | | $547.83 | $609.46 | $992.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,377.82 / $4,402.00 / $15,220.00
| Facility | | $1,377.82 | $4,402.00 | $15,220.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $603.35 / $1,039.68 / $5,404.02
| Professional | | $603.35 | $1,039.68 | $5,404.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $631.01 / $1,007.23 / $1,741.17
| Professional | | $631.01 | $1,007.23 | $1,741.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $615.15 / $1,333.52 / $6,679.00
| Facility | | $615.15 | $1,333.52 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $705.88 / $855.06 / $1,173.50
| Professional | | $705.88 | $855.06 | $1,173.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $764.31 / $1,515.17 / $1,998.75
| Professional | | $764.31 | $1,515.17 | $1,998.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,206.72 / $4,206.72 / $4,206.72
| Facility | | $4,206.72 | $4,206.72 | $4,206.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,155.00 / $5,268.00 / $26,542.00
| Facility | | $2,155.00 | $5,268.00 | $26,542.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $660.49 / $1,128.67 / $5,404.02
| Professional | | $660.49 | $1,128.67 | $5,404.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,155.00 / $4,983.00 / $8,810.00
| Facility | | $2,155.00 | $4,983.00 | $8,810.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $646.45 / $971.41 / $2,004.46
| Professional | | $646.45 | $971.41 | $2,004.46 |