- 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
- $261.36 / $322.72 / $785.46
| Professional | | $261.36 | $322.72 | $785.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $623.11 / $3,818.90 / $12,379.00
| Facility | | $623.11 | $3,818.90 | $12,379.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $258.72 / $546.08 / $2,900.23
| Professional | | $258.72 | $546.08 | $2,900.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $349.50 / $525.15 / $951.77
| Professional | | $349.50 | $525.15 | $951.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $262.30 / $546.08 / $6,679.00
| Facility | | $262.30 | $546.08 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $158.49 / $299.79 / $475.75
| Professional | | $158.49 | $299.79 | $475.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $321.54 / $641.28 / $966.22
| Professional | | $321.54 | $641.28 | $966.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,058.06 / $3,217.35 / $4,436.96
| Facility | | $3,058.06 | $3,217.35 | $4,436.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $405.70 / $405.70 / $405.70
| Professional | | $405.70 | $405.70 | $405.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,061.00 / $4,525.00 / $26,542.00
| Facility | | $1,061.00 | $4,525.00 | $26,542.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $313.36 / $599.72 / $2,900.23
| Professional | | $313.36 | $599.72 | $2,900.23 |
- 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
- $295.60 / $454.83 / $952.25
| Professional | | $295.60 | $454.83 | $952.25 |