- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,924.00 / $2,747.00 / $5,039.00
| Facility | | $1,924.00 | $2,747.00 | $5,039.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $554.63 / $619.99 / $881.56
| Professional | | $554.63 | $619.99 | $881.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,296.21 / $3,764.00 / $9,039.00
| Facility | | $1,296.21 | $3,764.00 | $9,039.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $499.38 / $797.21 / $4,151.12
| Professional | | $499.38 | $797.21 | $4,151.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $855.84 / $855.84 / $1,316.29
| Professional | | $855.84 | $855.84 | $1,316.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,346.32 / $1,346.32 / $1,346.32
| Facility | | $1,346.32 | $1,346.32 | $1,346.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $533.44 / $1,019.86 / $1,803.95
| Professional | | $533.44 | $1,019.86 | $1,803.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $571.37 / $1,241.98 / $6,679.00
| Facility | | $571.37 | $1,241.98 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $631.36 / $791.76 / $1,092.94
| Professional | | $631.36 | $791.76 | $1,092.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $699.19 / $1,408.17 / $3,348.77
| Professional | | $699.19 | $1,408.17 | $3,348.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,685.00 / $4,249.00 / $26,542.00
| Facility | | $1,685.00 | $4,249.00 | $26,542.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $558.17 / $808.43 / $4,151.12
| Professional | | $558.17 | $808.43 | $4,151.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,685.00 / $3,715.00 / $8,766.00
| Facility | | $1,685.00 | $3,715.00 | $8,766.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $547.01 / $739.35 / $1,635.74
| Professional | | $547.01 | $739.35 | $1,635.74 |