- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,758.00 / $2,733.00 / $4,712.00
| Facility | | $1,758.00 | $2,733.00 | $4,712.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $491.91 / $567.22 / $915.00
| Professional | | $491.91 | $567.22 | $915.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,061.00 / $3,715.00 / $9,039.00
| Facility | | $1,061.00 | $3,715.00 | $9,039.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $583.64 / $983.57 / $4,269.52
| Professional | | $583.64 | $983.57 | $4,269.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $782.21 / $1,159.80 / $1,755.37
| Professional | | $782.21 | $1,159.80 | $1,755.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $592.91 / $926.56 / $1,656.41
| Professional | | $592.91 | $926.56 | $1,656.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $593.03 / $1,289.58 / $6,679.00
| Facility | | $593.03 | $1,289.58 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $680.50 / $824.31 / $1,134.83
| Professional | | $680.50 | $824.31 | $1,134.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $732.36 / $1,451.83 / $1,915.19
| Professional | | $732.36 | $1,451.83 | $1,915.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $894.51 / $894.51 / $894.51
| Professional | | $894.51 | $894.51 | $894.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,902.00 / $3,997.00 / $26,542.00
| Facility | | $1,902.00 | $3,997.00 | $26,542.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $627.96 / $1,084.05 / $4,269.52
| Professional | | $627.96 | $1,084.05 | $4,269.52 |
- 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
- $623.89 / $871.31 / $1,734.37
| Professional | | $623.89 | $871.31 | $1,734.37 |