- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,528.00 / $2,894.76 / $6,107.00
| Facility | | $2,528.00 | $2,894.76 | $6,107.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $536.16 / $646.72 / $1,379.62
| Professional | | $536.16 | $646.72 | $1,379.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,233.88 / $4,076.16 / $12,623.50
| Facility | | $1,233.88 | $4,076.16 | $12,623.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $562.07 / $1,066.60 / $5,199.17
| Professional | | $562.07 | $1,066.60 | $5,199.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $763.85 / $1,051.69 / $1,715.61
| Professional | | $763.85 | $1,051.69 | $1,715.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $640.85 / $1,123.73 / $2,072.08
| Professional | | $640.85 | $1,123.73 | $2,072.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $544.54 / $1,169.44 / $6,679.00
| Facility | | $544.54 | $1,169.44 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $335.61 / $624.87 / $1,007.42
| Professional | | $335.61 | $624.87 | $1,007.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $679.53 / $1,355.25 / $1,987.69
| Professional | | $679.53 | $1,355.25 | $1,987.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,902.00 / $4,525.00 / $26,542.00
| Facility | | $1,902.00 | $4,525.00 | $26,542.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $624.84 / $1,169.44 / $5,199.17
| Professional | | $624.84 | $1,169.44 | $5,199.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,902.00 / $3,764.00 / $8,766.00
| Facility | | $1,902.00 | $3,764.00 | $8,766.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $624.84 / $859.97 / $2,371.94
| Professional | | $624.84 | $859.97 | $2,371.94 |