- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,758.00 / $2,733.00 / $4,712.00
| Facility | | $1,758.00 | $2,733.00 | $4,712.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $410.31 / $422.36 / $673.63
| Professional | | $410.31 | $422.36 | $673.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $818.35 / $2,771.37 / $7,619.68
| Facility | | $818.35 | $2,771.37 | $7,619.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $433.44 / $824.63 / $3,827.26
| Professional | | $433.44 | $824.63 | $3,827.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $500.65 / $881.49 / $1,625.42
| Professional | | $500.65 | $881.49 | $1,625.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $424.41 / $913.60 / $6,679.00
| Facility | | $424.41 | $913.60 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $262.11 / $487.01 / $785.16
| Professional | | $262.11 | $487.01 | $785.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $528.38 / $1,053.80 / $1,550.47
| Professional | | $528.38 | $1,053.80 | $1,550.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $697.42 / $697.42 / $697.42
| Professional | | $697.42 | $697.42 | $697.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $3,715.00 / $9,496.40
| Facility | | $55.00 | $3,715.00 | $9,496.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $478.73 / $904.80 / $3,827.26
| Professional | | $478.73 | $904.80 | $3,827.26 |
- 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
- $477.05 / $647.10 / $1,390.94
| Professional | | $477.05 | $647.10 | $1,390.94 |