- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,758.00 / $2,733.00 / $4,806.64
| Facility | | $1,758.00 | $2,733.00 | $4,806.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $292.37 / $408.10 / $1,137.82
| Professional | | $292.37 | $408.10 | $1,137.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $886.94 / $5,481.31 / $26,542.00
| Facility | | $886.94 | $5,481.31 | $26,542.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $374.98 / $694.28 / $3,416.61
| Professional | | $374.98 | $694.28 | $3,416.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $604.70 / $844.26 / $1,399.68
| Professional | | $604.70 | $844.26 | $1,399.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $375.53 / $798.28 / $6,679.00
| Facility | | $375.53 | $798.28 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $441.05 / $544.52 / $973.56
| Professional | | $441.05 | $544.52 | $973.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $478.41 / $956.82 / $2,014.29
| Professional | | $478.41 | $956.82 | $2,014.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $607.76 / $607.76 / $607.76
| Professional | | $607.76 | $607.76 | $607.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,672.00 / $6,104.00 / $26,542.00
| Facility | | $1,672.00 | $6,104.00 | $26,542.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $493.24 / $798.28 / $3,416.61
| Professional | | $493.24 | $798.28 | $3,416.61 |
- 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
- $484.63 / $665.68 / $1,259.74
| Professional | | $484.63 | $665.68 | $1,259.74 |