- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,015.00 / $2,671.00 / $4,712.00
| Facility | | $1,015.00 | $2,671.00 | $4,712.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $404.82 / $471.35 / $776.26
| Professional | | $404.82 | $471.35 | $776.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,027.74 / $3,715.00 / $9,039.00
| Facility | | $1,027.74 | $3,715.00 | $9,039.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $468.98 / $851.98 / $4,139.31
| Professional | | $468.98 | $851.98 | $4,139.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $606.57 / $899.39 / $1,218.35
| Professional | | $606.57 | $899.39 | $1,218.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $471.60 / $805.19 / $1,293.45
| Professional | | $471.60 | $805.19 | $1,293.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $460.36 / $1,000.02 / $6,679.00
| Facility | | $460.36 | $1,000.02 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $528.26 / $639.90 / $880.02
| Professional | | $528.26 | $639.90 | $880.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $569.75 / $1,129.47 / $1,489.95
| Professional | | $569.75 | $1,129.47 | $1,489.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,705.48 / $3,997.00 / $26,542.00
| Facility | | $1,705.48 | $3,997.00 | $26,542.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $528.15 / $884.10 / $4,139.31
| Professional | | $528.15 | $884.10 | $4,139.31 |
- 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
- $516.35 / $750.53 / $1,349.30
| Professional | | $516.35 | $750.53 | $1,349.30 |