- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,758.00 / $2,747.00 / $5,454.00
| Facility | | $1,758.00 | $2,747.00 | $5,454.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $251.61 / $425.62 / $1,387.90
| Professional | | $251.61 | $425.62 | $1,387.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $853.69 / $5,481.31 / $26,542.00
| Facility | | $853.69 | $5,481.31 | $26,542.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $361.78 / $616.09 / $2,608.23
| Professional | | $361.78 | $616.09 | $2,608.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $501.68 / $692.92 / $916.47
| Professional | | $501.68 | $692.92 | $916.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $581.80 / $760.48 / $1,351.57
| Professional | | $581.80 | $760.48 | $1,351.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $359.45 / $768.08 / $6,679.00
| Facility | | $359.45 | $768.08 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $424.36 / $521.20 / $931.87
| Professional | | $424.36 | $521.20 | $931.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $454.66 / $909.32 / $1,477.64
| Professional | | $454.66 | $909.32 | $1,477.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,103.34 / $3,217.80 / $9,256.00
| Facility | | $3,103.34 | $3,217.80 | $9,256.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,137.84 / $1,137.84 / $1,137.84
| Professional | | $1,137.84 | $1,137.84 | $1,137.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,155.00 / $6,104.00 / $26,542.00
| Facility | | $2,155.00 | $6,104.00 | $26,542.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $463.73 / $734.17 / $2,608.23
| Professional | | $463.73 | $734.17 | $2,608.23 |
- 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
- $443.39 / $616.09 / $1,530.57
| Professional | | $443.39 | $616.09 | $1,530.57 |