- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,015.00 / $2,747.00 / $6,293.00
| Facility | | $1,015.00 | $2,747.00 | $6,293.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $401.69 / $545.08 / $2,716.61
| Professional | | $401.69 | $545.08 | $2,716.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $891.92 / $3,997.00 / $14,302.50
| Facility | | $891.92 | $3,997.00 | $14,302.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $388.82 / $782.64 / $4,908.00
| Professional | | $388.82 | $782.64 | $4,908.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $515.60 / $776.98 / $1,408.21
| Professional | | $515.60 | $776.98 | $1,408.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $379.80 / $805.62 / $6,679.00
| Facility | | $379.80 | $805.62 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.07 / $445.11 / $702.63
| Professional | | $234.07 | $445.11 | $702.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $475.14 / $947.62 / $1,432.56
| Professional | | $475.14 | $947.62 | $1,432.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,703.84 / $5,647.41 / $12,993.65
| Facility | | $3,703.84 | $5,647.41 | $12,993.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $601.45 / $652.65 / $919.82
| Professional | | $601.45 | $652.65 | $919.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,902.00 / $4,525.00 / $26,542.00
| Facility | | $1,902.00 | $4,525.00 | $26,542.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $505.88 / $834.76 / $4,908.00
| Professional | | $505.88 | $834.76 | $4,908.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,902.00 / $3,764.00 / $8,766.00
| Facility | | $1,902.00 | $3,764.00 | $8,766.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $503.66 / $745.95 / $1,504.19
| Professional | | $503.66 | $745.95 | $1,504.19 |