- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $364.86 / $2,663.12 / $4,395.25
| Facility | | $364.86 | $2,663.12 | $4,395.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $228.35 / $390.04 / $830.48
| Professional | | $228.35 | $390.04 | $830.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $774.56 / $2,871.43 / $12,379.00
| Facility | | $774.56 | $2,871.43 | $12,379.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $350.18 / $803.79 / $3,276.32
| Professional | | $350.18 | $803.79 | $3,276.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $374.95 / $487.44 / $860.14
| Facility | | $374.95 | $487.44 | $860.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $529.62 / $778.66 / $1,111.19
| Professional | | $529.62 | $778.66 | $1,111.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $517.89 / $892.86 / $1,618.83
| Professional | | $517.89 | $892.86 | $1,618.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $314.67 / $683.68 / $6,679.00
| Facility | | $314.67 | $683.68 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $529.64 / $669.26 / $1,141.68
| Professional | | $529.64 | $669.26 | $1,141.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $400.95 / $861.05 / $1,277.28
| Professional | | $400.95 | $861.05 | $1,277.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $918.00 / $918.00 / $918.00
| Professional | | $918.00 | $918.00 | $918.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,593.63 / $4,249.00 / $16,394.00
| Facility | | $1,593.63 | $4,249.00 | $16,394.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $514.02 / $1,232.48 / $3,276.32
| Professional | | $514.02 | $1,232.48 | $3,276.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,902.00 / $3,764.00 / $8,766.00
| Facility | | $1,902.00 | $3,764.00 | $8,766.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $411.46 / $700.04 / $1,531.85
| Professional | | $411.46 | $700.04 | $1,531.85 |