- 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
- $660.79 / $763.64 / $1,052.88
| Professional | | $660.79 | $763.64 | $1,052.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,485.00 / $4,983.00 / $10,138.40
| Facility | | $1,485.00 | $4,983.00 | $10,138.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $565.27 / $920.90 / $5,606.00
| Professional | | $565.27 | $920.90 | $5,606.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $855.84 / $855.84 / $2,160.52
| Professional | | $855.84 | $855.84 | $2,160.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,082.51 / $2,082.51 / $2,082.51
| Facility | | $2,082.51 | $2,082.51 | $2,082.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $572.88 / $1,165.19 / $2,123.86
| Professional | | $572.88 | $1,165.19 | $2,123.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $650.95 / $1,409.78 / $6,679.00
| Facility | | $650.95 | $1,409.78 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $719.30 / $898.73 / $1,240.60
| Professional | | $719.30 | $898.73 | $1,240.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $798.31 / $1,607.80 / $5,944.58
| Professional | | $798.31 | $1,607.80 | $5,944.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,155.00 / $5,572.00 / $26,542.00
| Facility | | $2,155.00 | $5,572.00 | $26,542.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $634.48 / $934.26 / $5,606.00
| Professional | | $634.48 | $934.26 | $5,606.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,155.00 / $4,402.00 / $8,810.00
| Facility | | $2,155.00 | $4,402.00 | $8,810.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $628.53 / $849.46 / $2,140.86
| Professional | | $628.53 | $849.46 | $2,140.86 |