- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,421.00 / $2,663.12 / $4,767.00
| Facility | | $1,421.00 | $2,663.12 | $4,767.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $363.79 / $420.98 / $945.18
| Professional | | $363.79 | $420.98 | $945.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $842.02 / $3,997.00 / $16,394.00
| Facility | | $842.02 | $3,997.00 | $16,394.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $338.09 / $701.54 / $2,638.56
| Professional | | $338.09 | $701.54 | $2,638.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $427.47 / $725.63 / $1,338.01
| Professional | | $427.47 | $725.63 | $1,338.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $360.17 / $773.36 / $6,679.00
| Facility | | $360.17 | $773.36 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $221.97 / $413.30 / $666.31
| Professional | | $221.97 | $413.30 | $666.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $446.87 / $891.24 / $1,291.27
| Professional | | $446.87 | $891.24 | $1,291.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,941.55 / $2,941.55 / $6,462.43
| Facility | | $2,941.55 | $2,941.55 | $6,462.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $545.53 / $545.53 / $638.26
| Professional | | $545.53 | $545.53 | $638.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,336.36 / $4,525.00 / $16,394.00
| Facility | | $1,336.36 | $4,525.00 | $16,394.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $405.70 / $787.32 / $2,638.56
| Professional | | $405.70 | $787.32 | $2,638.56 |
- 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
- $383.02 / $545.85 / $1,280.92
| Professional | | $383.02 | $545.85 | $1,280.92 |