- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,758.00 / $2,733.00 / $4,712.00
| Facility | | $1,758.00 | $2,733.00 | $4,712.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $571.62 / $648.82 / $910.31
| Professional | | $571.62 | $648.82 | $910.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,089.00 / $3,592.00 / $8,498.00
| Facility | | $1,089.00 | $3,592.00 | $8,498.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $489.92 / $801.33 / $4,101.52
| Professional | | $489.92 | $801.33 | $4,101.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $692.82 / $692.82 / $1,392.16
| Professional | | $692.82 | $692.82 | $1,392.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,593.42 / $1,593.42 / $1,593.42
| Facility | | $1,593.42 | $1,593.42 | $1,593.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $524.83 / $1,008.70 / $1,840.51
| Professional | | $524.83 | $1,008.70 | $1,840.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $562.95 / $1,220.46 / $6,679.00
| Facility | | $562.95 | $1,220.46 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $622.05 / $778.04 / $1,074.00
| Professional | | $622.05 | $778.04 | $1,074.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $690.18 / $1,390.02 / $4,054.78
| Professional | | $690.18 | $1,390.02 | $4,054.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,245.00 / $3,649.00 / $26,542.00
| Facility | | $1,245.00 | $3,649.00 | $26,542.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $565.11 / $810.09 / $4,101.52
| Professional | | $565.11 | $810.09 | $4,101.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,245.00 / $3,372.00 / $8,425.00
| Facility | | $1,245.00 | $3,372.00 | $8,425.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $549.29 / $754.99 / $1,666.53
| Professional | | $549.29 | $754.99 | $1,666.53 |