- 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
- $369.83 / $441.48 / $689.53
| Professional | | $369.83 | $441.48 | $689.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $949.44 / $3,715.00 / $9,039.00
| Facility | | $949.44 | $3,715.00 | $9,039.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $442.01 / $816.04 / $3,677.92
| Professional | | $442.01 | $816.04 | $3,677.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $560.79 / $831.49 / $1,126.39
| Professional | | $560.79 | $831.49 | $1,126.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $453.22 / $754.76 / $1,207.48
| Professional | | $453.22 | $754.76 | $1,207.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $425.91 / $924.52 / $6,679.00
| Facility | | $425.91 | $924.52 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $488.73 / $592.01 / $813.58
| Professional | | $488.73 | $592.01 | $813.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $528.38 / $1,047.46 / $1,381.77
| Professional | | $528.38 | $1,047.46 | $1,381.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $353.93 / $646.63 / $663.01
| Professional | | $353.93 | $646.63 | $663.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,583.36 / $3,997.00 / $16,394.00
| Facility | | $1,583.36 | $3,997.00 | $16,394.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $496.79 / $817.52 / $3,677.92
| Professional | | $496.79 | $817.52 | $3,677.92 |
- 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
- $473.33 / $737.70 / $1,341.03
| Professional | | $473.33 | $737.70 | $1,341.03 |