- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,015.00 / $2,733.00 / $4,806.64
| Facility | | $1,015.00 | $2,733.00 | $4,806.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $756.81 / $998.43 / $3,069.73
| Professional | | $756.81 | $998.43 | $3,069.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,640.74 / $3,818.90 / $16,742.00
| Facility | | $1,640.74 | $3,818.90 | $16,742.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $716.84 / $1,470.16 / $5,588.00
| Professional | | $716.84 | $1,470.16 | $5,588.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $864.58 / $1,488.94 / $2,745.51
| Professional | | $864.58 | $1,488.94 | $2,745.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $738.89 / $1,576.26 / $6,679.00
| Facility | | $738.89 | $1,576.26 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $455.38 / $867.13 / $1,366.95
| Professional | | $455.38 | $867.13 | $1,366.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $920.78 / $1,836.40 / $2,668.56
| Professional | | $920.78 | $1,836.40 | $2,668.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,115.38 / $4,115.38 / $4,115.38
| Facility | | $4,115.38 | $4,115.38 | $4,115.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,160.80 / $1,160.80 / $1,160.80
| Professional | | $1,160.80 | $1,160.80 | $1,160.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,324.00 / $6,280.00 / $26,542.00
| Facility | | $2,324.00 | $6,280.00 | $26,542.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $911.65 / $1,649.92 / $5,588.00
| Professional | | $911.65 | $1,649.92 | $5,588.00 |
- 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
- $844.80 / $1,217.36 / $2,711.39
| Professional | | $844.80 | $1,217.36 | $2,711.39 |