- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,015.00 / $2,671.00 / $4,712.00
| Facility | | $1,015.00 | $2,671.00 | $4,712.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $303.52 / $339.53 / $740.32
| Professional | | $303.52 | $339.53 | $740.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $718.23 / $3,997.00 / $12,379.00
| Facility | | $718.23 | $3,997.00 | $12,379.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $279.77 / $587.54 / $2,178.80
| Professional | | $279.77 | $587.54 | $2,178.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $389.21 / $596.76 / $1,100.39
| Professional | | $389.21 | $596.76 | $1,100.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $300.00 / $631.58 / $6,679.00
| Facility | | $300.00 | $631.58 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $182.25 / $343.97 / $547.08
| Professional | | $182.25 | $343.97 | $547.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $368.23 / $734.40 / $1,066.70
| Professional | | $368.23 | $734.40 | $1,066.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $239.90 / $239.90 / $239.90
| Professional | | $239.90 | $239.90 | $239.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,377.55 / $4,525.00 / $26,542.00
| Facility | | $1,377.55 | $4,525.00 | $26,542.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $341.94 / $659.38 / $2,178.80
| Professional | | $341.94 | $659.38 | $2,178.80 |
- 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
- $337.99 / $462.37 / $920.51
| Professional | | $337.99 | $462.37 | $920.51 |