- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,758.00 / $2,747.00 / $4,712.00
| Facility | | $1,758.00 | $2,747.00 | $4,712.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $360.49 / $368.88 / $523.63
| Professional | | $360.49 | $368.88 | $523.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $880.82 / $6,078.00 / $21,130.00
| Facility | | $880.82 | $6,078.00 | $21,130.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $378.24 / $683.57 / $2,806.88
| Professional | | $378.24 | $683.57 | $2,806.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $516.00 / $710.44 / $1,158.94
| Professional | | $516.00 | $710.44 | $1,158.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $432.91 / $758.91 / $1,399.38
| Professional | | $432.91 | $758.91 | $1,399.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $368.08 / $789.98 / $6,679.00
| Facility | | $368.08 | $789.98 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $226.85 / $422.37 / $680.95
| Professional | | $226.85 | $422.37 | $680.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $459.57 / $916.57 / $1,343.85
| Professional | | $459.57 | $916.57 | $1,343.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,386.00 / $7,292.00 / $26,542.00
| Facility | | $2,386.00 | $7,292.00 | $26,542.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $435.64 / $789.98 / $2,806.88
| Professional | | $435.64 | $789.98 | $2,806.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,386.00 / $5,904.00 / $13,017.00
| Facility | | $2,386.00 | $5,904.00 | $13,017.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $418.70 / $557.12 / $1,237.73
| Professional | | $418.70 | $557.12 | $1,237.73 |