- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,421.00 / $2,663.12 / $3,693.00
| Facility | | $1,421.00 | $2,663.12 | $3,693.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $424.00 / $510.71 / $826.85
| Professional | | $424.00 | $510.71 | $826.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,061.00 / $3,630.26 / $9,039.00
| Facility | | $1,061.00 | $3,630.26 | $9,039.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $448.49 / $842.75 / $3,589.52
| Professional | | $448.49 | $842.75 | $3,589.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $998.44 / $998.50 / $2,319.83
| Professional | | $998.44 | $998.50 | $2,319.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $526.55 / $820.60 / $1,362.24
| Professional | | $526.55 | $820.60 | $1,362.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $509.59 / $1,110.22 / $6,679.00
| Facility | | $509.59 | $1,110.22 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $584.75 / $708.33 / $976.99
| Professional | | $584.75 | $708.33 | $976.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $641.84 / $1,272.38 / $2,021.56
| Professional | | $641.84 | $1,272.38 | $2,021.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,902.00 / $3,997.00 / $16,394.00
| Facility | | $1,902.00 | $3,997.00 | $16,394.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $480.00 / $842.75 / $3,589.52
| Professional | | $480.00 | $842.75 | $3,589.52 |
- 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
- $460.72 / $697.47 / $1,478.42
| Professional | | $460.72 | $697.47 | $1,478.42 |