- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,758.00 / $2,747.00 / $6,020.88
| Facility | | $1,758.00 | $2,747.00 | $6,020.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $365.34 / $425.30 / $1,070.36
| Professional | | $365.34 | $425.30 | $1,070.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $941.10 / $3,630.26 / $9,039.00
| Facility | | $941.10 | $3,630.26 | $9,039.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $382.82 / $686.78 / $3,232.86
| Professional | | $382.82 | $686.78 | $3,232.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $584.00 / $807.30 / $1,090.22
| Professional | | $584.00 | $807.30 | $1,090.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $422.68 / $671.62 / $1,107.81
| Professional | | $422.68 | $671.62 | $1,107.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $412.54 / $894.84 / $6,679.00
| Facility | | $412.54 | $894.84 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $473.39 / $573.42 / $787.46
| Professional | | $473.39 | $573.42 | $787.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $512.00 / $1,014.99 / $1,615.15
| Professional | | $512.00 | $1,014.99 | $1,615.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,823.53 / $1,823.53 / $6,517.90
| Facility | | $1,823.53 | $1,823.53 | $6,517.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $293.41 / $339.10 / $640.91
| Professional | | $293.41 | $339.10 | $640.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,902.00 / $3,997.00 / $26,542.00
| Facility | | $1,902.00 | $3,997.00 | $26,542.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $405.04 / $717.62 / $3,232.86
| Professional | | $405.04 | $717.62 | $3,232.86 |
- 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
- $388.55 / $606.20 / $1,288.70
| Professional | | $388.55 | $606.20 | $1,288.70 |