- 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
- $316.57 / $358.78 / $593.38
| Professional | | $316.57 | $358.78 | $593.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $853.38 / $3,715.00 / $9,039.00
| Facility | | $853.38 | $3,715.00 | $9,039.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $367.96 / $662.06 / $2,790.22
| Professional | | $367.96 | $662.06 | $2,790.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $384.13 / $614.80 / $1,006.30
| Professional | | $384.13 | $614.80 | $1,006.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $361.33 / $787.68 / $6,679.00
| Facility | | $361.33 | $787.68 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $414.63 / $502.25 / $693.16
| Professional | | $414.63 | $502.25 | $693.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $446.46 / $885.06 / $1,167.54
| Professional | | $446.46 | $885.06 | $1,167.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,341.72 / $4,341.72 / $4,341.72
| Facility | | $4,341.72 | $4,341.72 | $4,341.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $310.33 / $310.33 / $310.33
| Professional | | $310.33 | $310.33 | $310.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,336.24 / $3,997.00 / $16,394.00
| Facility | | $1,336.24 | $3,997.00 | $16,394.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $391.28 / $671.14 / $2,790.22
| Professional | | $391.28 | $671.14 | $2,790.22 |
- 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
- $391.28 / $628.07 / $1,172.46
| Professional | | $391.28 | $628.07 | $1,172.46 |