- 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
- $621.85 / $747.76 / $1,055.05
| Professional | | $621.85 | $747.76 | $1,055.05 |
- 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
- $555.35 / $904.25 / $5,206.00
| Professional | | $555.35 | $904.25 | $5,206.00 |
- 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
- $559.05 / $1,145.00 / $2,085.77
| Professional | | $559.05 | $1,145.00 | $2,085.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $639.49 / $1,385.36 / $6,679.00
| Facility | | $639.49 | $1,385.36 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $706.64 / $883.17 / $1,219.11
| Professional | | $706.64 | $883.17 | $1,219.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $784.38 / $1,579.74 / $5,944.58
| Professional | | $784.38 | $1,579.74 | $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
- $623.01 / $916.50 / $5,206.00
| Professional | | $623.01 | $916.50 | $5,206.00 |
- 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
- $617.66 / $821.56 / $1,965.40
| Professional | | $617.66 | $821.56 | $1,965.40 |