- 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
- $364.14 / $394.28 / $624.20
| Professional | | $364.14 | $394.28 | $624.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $913.05 / $5,508.58 / $19,078.05
| Facility | | $913.05 | $5,508.58 | $19,078.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $418.44 / $736.31 / $3,959.35
| Professional | | $418.44 | $736.31 | $3,959.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $458.01 / $751.04 / $1,017.47
| Professional | | $458.01 | $751.04 | $1,017.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $427.47 / $693.80 / $1,118.33
| Professional | | $427.47 | $693.80 | $1,118.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $390.33 / $835.14 / $6,679.00
| Facility | | $390.33 | $835.14 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $447.90 / $542.55 / $734.92
| Professional | | $447.90 | $542.55 | $734.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $482.51 / $956.53 / $1,261.81
| Professional | | $482.51 | $956.53 | $1,261.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,697.00 / $6,078.00 / $26,542.00
| Facility | | $1,697.00 | $6,078.00 | $26,542.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $452.68 / $766.63 / $3,959.35
| Professional | | $452.68 | $766.63 | $3,959.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,386.00 / $5,904.00 / $13,017.00
| Facility | | $2,386.00 | $5,904.00 | $13,017.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $442.62 / $671.59 / $1,129.24
| Professional | | $442.62 | $671.59 | $1,129.24 |