- 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
- $490.63 / $569.76 / $786.04
| Professional | | $490.63 | $569.76 | $786.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,160.09 / $4,983.00 / $10,138.40
| Facility | | $1,160.09 | $4,983.00 | $10,138.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $422.99 / $690.58 / $3,533.68
| Professional | | $422.99 | $690.58 | $3,533.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $692.82 / $692.82 / $2,160.52
| Professional | | $692.82 | $692.82 | $2,160.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,082.51 / $2,082.51 / $2,082.51
| Facility | | $2,082.51 | $2,082.51 | $2,082.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $450.64 / $865.65 / $1,585.02
| Professional | | $450.64 | $865.65 | $1,585.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $483.97 / $1,047.35 / $6,679.00
| Facility | | $483.97 | $1,047.35 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $534.79 / $667.69 / $921.68
| Professional | | $534.79 | $667.69 | $921.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $593.91 / $1,196.15 / $5,944.58
| Professional | | $593.91 | $1,196.15 | $5,944.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,155.00 / $5,572.00 / $26,542.00
| Facility | | $2,155.00 | $5,572.00 | $26,542.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $488.77 / $699.74 / $3,533.68
| Professional | | $488.77 | $699.74 | $3,533.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,155.00 / $4,402.00 / $8,810.00
| Facility | | $2,155.00 | $4,402.00 | $8,810.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $474.27 / $641.66 / $1,433.41
| Professional | | $474.27 | $641.66 | $1,433.41 |