- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,924.00 / $2,747.00 / $5,048.00
| Facility | | $1,924.00 | $2,747.00 | $5,048.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $441.80 / $536.71 / $1,197.10
| Professional | | $441.80 | $536.71 | $1,197.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,057.95 / $3,997.00 / $12,379.00
| Facility | | $1,057.95 | $3,997.00 | $12,379.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $423.67 / $889.71 / $3,830.56
| Professional | | $423.67 | $889.71 | $3,830.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $530.03 / $871.90 / $1,354.33
| Professional | | $530.03 | $871.90 | $1,354.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $569.96 / $910.20 / $1,678.36
| Professional | | $569.96 | $910.20 | $1,678.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $451.51 / $966.44 / $6,679.00
| Facility | | $451.51 | $966.44 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $278.27 / $518.11 / $835.29
| Professional | | $278.27 | $518.11 | $835.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $561.15 / $1,119.16 / $1,626.93
| Professional | | $561.15 | $1,119.16 | $1,626.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,959.89 / $5,142.85 / $6,607.16
| Facility | | $4,959.89 | $5,142.85 | $6,607.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $365.90 / $365.90 / $713.69
| Professional | | $365.90 | $365.90 | $713.69 |
- 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
- $512.91 / $998.50 / $3,830.56
| Professional | | $512.91 | $998.50 | $3,830.56 |
- 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
- $402.44 / $701.93 / $1,535.48
| Professional | | $402.44 | $701.93 | $1,535.48 |