- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,012.00 / $2,663.12 / $4,712.00
| Facility | | $1,012.00 | $2,663.12 | $4,712.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $299.52 / $399.51 / $994.48
| Professional | | $299.52 | $399.51 | $994.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $849.66 / $2,826.85 / $9,039.00
| Facility | | $849.66 | $2,826.85 | $9,039.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $366.00 / $650.10 / $2,571.36
| Professional | | $366.00 | $650.10 | $2,571.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $517.94 / $710.01 / $958.84
| Professional | | $517.94 | $710.01 | $958.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $358.59 / $621.64 / $1,004.93
| Professional | | $358.59 | $621.64 | $1,004.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $359.60 / $787.02 / $6,679.00
| Facility | | $359.60 | $787.02 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $412.64 / $501.73 / $692.58
| Professional | | $412.64 | $501.73 | $692.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $441.96 / $876.14 / $1,155.77
| Professional | | $441.96 | $876.14 | $1,155.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,276.10 / $3,399.38 / $4,436.96
| Facility | | $1,276.10 | $3,399.38 | $4,436.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $257.50 / $371.68 / $743.37
| Professional | | $257.50 | $371.68 | $743.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,320.16 / $3,997.00 / $26,542.00
| Facility | | $1,320.16 | $3,997.00 | $26,542.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $399.88 / $658.80 / $2,571.36
| Professional | | $399.88 | $658.80 | $2,571.36 |
- 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
- $391.82 / $576.53 / $1,121.17
| Professional | | $391.82 | $576.53 | $1,121.17 |