- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,055.50 / $2,671.00 / $4,712.00
| Facility | | $1,055.50 | $2,671.00 | $4,712.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $360.87 / $430.45 / $615.14
| Professional | | $360.87 | $430.45 | $615.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $736.00 / $1,680.67 / $4,142.00
| Facility | | $736.00 | $1,680.67 | $4,142.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $399.87 / $603.22 / $1,489.66
| Professional | | $399.87 | $603.22 | $1,489.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $531.88 / $745.76 / $1,790.40
| Professional | | $531.88 | $745.76 | $1,790.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $83.43 / $3,504.00 / $9,239.00
| Facility | | $83.43 | $3,504.00 | $9,239.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $660.99 / $660.99 / $777.63
| Professional | | $660.99 | $660.99 | $777.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $606.62 / $1,137.41 / $1,510.85
| Professional | | $606.62 | $1,137.41 | $1,510.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,931.75 / $1,931.75 / $1,931.75
| Facility | | $1,931.75 | $1,931.75 | $1,931.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $627.00 / $2,391.00 / $26,542.00
| Facility | | $627.00 | $2,391.00 | $26,542.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $335.30 / $585.40 / $3,504.08
| Professional | | $335.30 | $585.40 | $3,504.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $627.00 / $1,818.00 / $2,733.00
| Facility | | $627.00 | $1,818.00 | $2,733.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $259.29 / $516.23 / $1,116.39
| Professional | | $259.29 | $516.23 | $1,116.39 |