- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,758.00 / $2,671.00 / $4,712.00
| Facility | | $1,758.00 | $2,671.00 | $4,712.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $434.97 / $548.32 / $1,094.08
| Professional | | $434.97 | $548.32 | $1,094.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $946.35 / $2,826.85 / $8,498.00
| Facility | | $946.35 | $2,826.85 | $8,498.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $557.04 / $995.20 / $4,030.73
| Professional | | $557.04 | $995.20 | $4,030.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $670.11 / $1,067.49 / $1,457.96
| Professional | | $670.11 | $1,067.49 | $1,457.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $570.64 / $915.18 / $1,583.57
| Professional | | $570.64 | $915.18 | $1,583.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $554.17 / $1,221.88 / $6,679.00
| Facility | | $554.17 | $1,221.88 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $635.91 / $775.85 / $1,075.25
| Professional | | $635.91 | $775.85 | $1,075.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $676.66 / $1,341.41 / $1,769.53
| Professional | | $676.66 | $1,341.41 | $1,769.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,341.72 / $4,341.72 / $4,501.87
| Facility | | $4,341.72 | $4,341.72 | $4,501.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,640.00 / $3,592.00 / $26,542.00
| Facility | | $1,640.00 | $3,592.00 | $26,542.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $602.94 / $1,014.40 / $4,030.73
| Professional | | $602.94 | $1,014.40 | $4,030.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,640.00 / $3,372.00 / $8,425.00
| Facility | | $1,640.00 | $3,372.00 | $8,425.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $602.94 / $855.32 / $1,627.31
| Professional | | $602.94 | $855.32 | $1,627.31 |