- 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
- $467.98 / $532.09 / $744.48
| Professional | | $467.98 | $532.09 | $744.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,061.00 / $3,764.00 / $9,039.00
| Facility | | $1,061.00 | $3,764.00 | $9,039.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $401.61 / $660.21 / $3,355.68
| Professional | | $401.61 | $660.21 | $3,355.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $692.82 / $692.82 / $1,392.16
| Professional | | $692.82 | $692.82 | $1,392.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,593.42 / $1,593.42 / $1,593.42
| Facility | | $1,593.42 | $1,593.42 | $1,593.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $430.35 / $827.22 / $1,507.96
| Professional | | $430.35 | $827.22 | $1,507.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $461.21 / $1,000.86 / $6,679.00
| Facility | | $461.21 | $1,000.86 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $509.64 / $638.04 / $880.76
| Professional | | $509.64 | $638.04 | $880.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $565.25 / $1,138.41 / $4,054.78
| Professional | | $565.25 | $1,138.41 | $4,054.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,685.00 / $4,249.00 / $26,542.00
| Facility | | $1,685.00 | $4,249.00 | $26,542.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $462.63 / $701.39 / $3,355.68
| Professional | | $462.63 | $701.39 | $3,355.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,685.00 / $3,715.00 / $8,766.00
| Facility | | $1,685.00 | $3,715.00 | $8,766.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $450.07 / $635.39 / $1,367.64
| Professional | | $450.07 | $635.39 | $1,367.64 |