- 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
- $264.70 / $438.95 / $1,068.23
| Professional | | $264.70 | $438.95 | $1,068.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $917.12 / $4,983.00 / $9,351.96
| Facility | | $917.12 | $4,983.00 | $9,351.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $367.84 / $641.72 / $2,804.16
| Professional | | $367.84 | $641.72 | $2,804.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $555.92 / $817.85 / $1,453.53
| Professional | | $555.92 | $817.85 | $1,453.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $386.55 / $827.52 / $6,679.00
| Facility | | $386.55 | $827.52 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $457.20 / $560.50 / $1,002.13
| Professional | | $457.20 | $560.50 | $1,002.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $487.42 / $974.84 / $1,584.12
| Professional | | $487.42 | $974.84 | $1,584.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,299.72 / $4,299.72 / $4,299.72
| Facility | | $4,299.72 | $4,299.72 | $4,299.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $4,402.00 / $11,082.10
| Facility | | $55.00 | $4,402.00 | $11,082.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $503.06 / $734.19 / $2,804.16
| Professional | | $503.06 | $734.19 | $2,804.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,155.00 / $4,983.00 / $8,810.00
| Facility | | $2,155.00 | $4,983.00 | $8,810.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $496.44 / $627.92 / $1,182.69
| Professional | | $496.44 | $627.92 | $1,182.69 |