- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,015.00 / $2,733.00 / $4,712.00
| Facility | | $1,015.00 | $2,733.00 | $4,712.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $424.31 / $505.46 / $1,381.80
| Professional | | $424.31 | $505.46 | $1,381.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $772.29 / $2,651.22 / $5,737.16
| Facility | | $772.29 | $2,651.22 | $5,737.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $477.62 / $780.88 / $3,374.72
| Professional | | $477.62 | $780.88 | $3,374.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $664.25 / $925.30 / $1,229.69
| Professional | | $664.25 | $925.30 | $1,229.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $493.58 / $802.78 / $1,350.72
| Professional | | $493.58 | $802.78 | $1,350.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $468.29 / $1,009.32 / $6,679.00
| Facility | | $468.29 | $1,009.32 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $537.36 / $650.91 / $888.20
| Professional | | $537.36 | $650.91 | $888.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $587.37 / $1,164.40 / $1,536.03
| Professional | | $587.37 | $1,164.40 | $1,536.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,704.96 / $2,828.70 / $3,863.50
| Facility | | $1,704.96 | $2,828.70 | $3,863.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $880.31 / $1,351.12 / $1,469.72
| Professional | | $880.31 | $1,351.12 | $1,469.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $2,854.00 / $9,039.00
| Facility | | $55.00 | $2,854.00 | $9,039.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $514.23 / $825.55 / $3,374.72
| Professional | | $514.23 | $825.55 | $3,374.72 |
- 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
- $499.26 / $731.25 / $1,390.23
| Professional | | $499.26 | $731.25 | $1,390.23 |