- 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
- $649.85 / $749.31 / $1,036.58
| Professional | | $649.85 | $749.31 | $1,036.58 |
- 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
- $548.63 / $910.77 / $4,679.35
| Professional | | $548.63 | $910.77 | $4,679.35 |
- 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
- $550.10 / $1,148.67 / $2,093.63
| Professional | | $550.10 | $1,148.67 | $2,093.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $641.58 / $1,389.80 / $6,679.00
| Facility | | $641.58 | $1,389.80 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $708.95 / $886.00 / $1,223.02
| Professional | | $708.95 | $886.00 | $1,223.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $786.84 / $1,584.70 / $5,944.58
| Professional | | $786.84 | $1,584.70 | $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
- $625.01 / $920.73 / $4,679.35
| Professional | | $625.01 | $920.73 | $4,679.35 |
- 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
- $624.32 / $824.26 / $1,892.42
| Professional | | $624.32 | $824.26 | $1,892.42 |