- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,421.00 / $2,663.12 / $3,693.00
| Facility | | $1,421.00 | $2,663.12 | $3,693.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $257.02 / $318.86 / $808.95
| Professional | | $257.02 | $318.86 | $808.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $608.36 / $5,097.00 / $16,394.00
| Facility | | $608.36 | $5,097.00 | $16,394.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $270.64 / $591.97 / $7,906.73
| Professional | | $270.64 | $591.97 | $7,906.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $334.89 / $511.66 / $927.32
| Professional | | $334.89 | $511.66 | $927.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $255.47 / $529.66 / $6,679.00
| Facility | | $255.47 | $529.66 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $154.36 / $292.64 / $466.10
| Professional | | $154.36 | $292.64 | $466.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $314.16 / $626.55 / $945.12
| Professional | | $314.16 | $626.55 | $945.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,763.01 / $1,763.01 / $2,034.65
| Facility | | $1,763.01 | $1,763.01 | $2,034.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $581.97 / $581.97 / $614.13
| Professional | | $581.97 | $581.97 | $614.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,591.00 / $6,280.00 / $16,394.00
| Facility | | $1,591.00 | $6,280.00 | $16,394.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $332.28 / $717.20 / $7,906.73
| Professional | | $332.28 | $717.20 | $7,906.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,324.00 / $6,280.00 / $14,708.86
| Facility | | $2,324.00 | $6,280.00 | $14,708.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $332.11 / $513.80 / $1,284.64
| Professional | | $332.11 | $513.80 | $1,284.64 |