- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,758.00 / $2,733.00 / $4,806.64
| Facility | | $1,758.00 | $2,733.00 | $4,806.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $954.84 / $1,263.93 / $2,913.09
| Professional | | $954.84 | $1,263.93 | $2,913.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,672.00 / $5,268.00 / $26,542.00
| Facility | | $1,672.00 | $5,268.00 | $26,542.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $911.86 / $1,856.53 / $6,877.00
| Professional | | $911.86 | $1,856.53 | $6,877.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,181.09 / $1,905.71 / $3,453.90
| Professional | | $1,181.09 | $1,905.71 | $3,453.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $930.59 / $1,909.00 / $6,679.00
| Facility | | $930.59 | $1,909.00 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $573.52 / $1,095.57 / $1,721.59
| Professional | | $573.52 | $1,095.57 | $1,721.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,160.81 / $2,315.12 / $3,363.76
| Professional | | $1,160.81 | $2,315.12 | $3,363.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $276.20 / $276.20 / $276.20
| Professional | | $276.20 | $276.20 | $276.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,155.00 / $6,104.00 / $26,542.00
| Facility | | $2,155.00 | $6,104.00 | $26,542.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,113.40 / $2,083.53 / $6,877.00
| Professional | | $1,113.40 | $2,083.53 | $6,877.00 |
- 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
- $1,065.54 / $1,532.26 / $3,150.14
| Professional | | $1,065.54 | $1,532.26 | $3,150.14 |