- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,758.00 / $2,747.00 / $4,712.00
| Facility | | $1,758.00 | $2,747.00 | $4,712.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $486.56 / $528.33 / $856.15
| Professional | | $486.56 | $528.33 | $856.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,236.00 / $5,508.58 / $14,018.00
| Facility | | $1,236.00 | $5,508.58 | $14,018.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $525.20 / $918.18 / $3,970.80
| Professional | | $525.20 | $918.18 | $3,970.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $550.48 / $885.51 / $1,545.76
| Professional | | $550.48 | $885.51 | $1,545.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $553.13 / $1,202.80 / $6,679.00
| Facility | | $553.13 | $1,202.80 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $634.72 / $768.85 / $1,058.46
| Professional | | $634.72 | $768.85 | $1,058.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $685.26 / $1,358.46 / $1,792.02
| Professional | | $685.26 | $1,358.46 | $1,792.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,115.81 / $3,115.81 / $3,115.81
| Facility | | $3,115.81 | $3,115.81 | $3,115.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $983.47 / $983.47 / $983.47
| Professional | | $983.47 | $983.47 | $983.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,052.71 / $6,078.00 / $26,542.00
| Facility | | $2,052.71 | $6,078.00 | $26,542.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $566.13 / $1,013.80 / $3,970.80
| Professional | | $566.13 | $1,013.80 | $3,970.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,386.00 / $5,904.00 / $13,017.00
| Facility | | $2,386.00 | $5,904.00 | $13,017.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $557.58 / $831.34 / $1,756.30
| Professional | | $557.58 | $831.34 | $1,756.30 |