- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,486.00 / $2,663.12 / $4,674.00
| Facility | | $1,486.00 | $2,663.12 | $4,674.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $377.59 / $439.98 / $985.15
| Professional | | $377.59 | $439.98 | $985.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $818.35 / $2,338.00 / $8,498.00
| Facility | | $818.35 | $2,338.00 | $8,498.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $388.13 / $732.12 / $2,751.20
| Professional | | $388.13 | $732.12 | $2,751.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $480.48 / $755.81 / $1,393.67
| Professional | | $480.48 | $755.81 | $1,393.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $300.00 / $601.37 / $8,090.00
| Facility | | $300.00 | $601.37 | $8,090.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $230.76 / $443.01 / $692.68
| Professional | | $230.76 | $443.01 | $692.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $465.31 / $928.01 / $1,345.03
| Professional | | $465.31 | $928.01 | $1,345.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,863.50 / $3,863.50 / $3,863.50
| Facility | | $3,863.50 | $3,863.50 | $3,863.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $704.12 / $704.12 / $704.12
| Professional | | $704.12 | $704.12 | $704.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $3,133.00 / $9,388.90
| Facility | | $55.00 | $3,133.00 | $9,388.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $446.84 / $801.82 / $2,751.20
| Professional | | $446.84 | $801.82 | $2,751.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,450.00 / $3,592.00 / $8,498.00
| Facility | | $1,450.00 | $3,592.00 | $8,498.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $422.29 / $633.44 / $1,368.69
| Professional | | $422.29 | $633.44 | $1,368.69 |