- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,421.00 / $2,663.12 / $3,693.00
| Facility | | $1,421.00 | $2,663.12 | $3,693.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $332.92 / $377.53 / $586.26
| Professional | | $332.92 | $377.53 | $586.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $897.03 / $2,826.85 / $9,039.00
| Facility | | $897.03 | $2,826.85 | $9,039.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $385.63 / $696.35 / $3,344.07
| Professional | | $385.63 | $696.35 | $3,344.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $745.03 / $759.47 / $1,127.67
| Professional | | $745.03 | $759.47 | $1,127.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $392.79 / $664.26 / $1,057.68
| Professional | | $392.79 | $664.26 | $1,057.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $380.13 / $828.44 / $6,679.00
| Facility | | $380.13 | $828.44 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $436.20 / $528.38 / $729.03
| Professional | | $436.20 | $528.38 | $729.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $469.81 / $931.35 / $1,228.59
| Professional | | $469.81 | $931.35 | $1,228.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,406.24 / $3,997.00 / $16,394.00
| Facility | | $1,406.24 | $3,997.00 | $16,394.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $418.76 / $725.96 / $3,344.07
| Professional | | $418.76 | $725.96 | $3,344.07 |
- 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
- $408.52 / $690.62 / $1,228.59
| Professional | | $408.52 | $690.62 | $1,228.59 |