- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,639.72 / $2,747.00 / $5,454.00
| Facility | | $1,639.72 | $2,747.00 | $5,454.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $500.01 / $1,264.44 / $1,639.72
| Professional | | $500.01 | $1,264.44 | $1,639.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $371.76 / $985.83 / $4,050.00
| Facility | | $371.76 | $985.83 | $4,050.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $308.10 / $517.08 / $7,231.97
| Professional | | $308.10 | $517.08 | $7,231.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $510.75 / $705.44 / $952.67
| Professional | | $510.75 | $705.44 | $952.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $519.75 / $726.77 / $2,455.03
| Professional | | $519.75 | $726.77 | $2,455.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $300.00 / $533.98 / $8,090.00
| Facility | | $300.00 | $533.98 | $8,090.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $387.81 / $473.14 / $752.25
| Professional | | $387.81 | $473.14 | $752.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $452.20 / $896.44 / $1,138.19
| Professional | | $452.20 | $896.44 | $1,138.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $2,446.00 / $5,876.00
| Facility | | $55.00 | $2,446.00 | $5,876.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $329.89 / $586.83 / $7,231.97
| Professional | | $329.89 | $586.83 | $7,231.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $953.00 / $3,325.00 / $4,662.00
| Facility | | $953.00 | $3,325.00 | $4,662.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $326.58 / $473.45 / $1,102.67
| Professional | | $326.58 | $473.45 | $1,102.67 |