- 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
- $503.13 / $559.20 / $800.55
| Professional | | $503.13 | $559.20 | $800.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,185.11 / $3,764.00 / $11,879.05
| Facility | | $1,185.11 | $3,764.00 | $11,879.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $431.14 / $705.26 / $3,606.16
| Professional | | $431.14 | $705.26 | $3,606.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $605.88 / $605.88 / $2,643.41
| Professional | | $605.88 | $605.88 | $2,643.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,748.18 / $2,748.18 / $2,748.18
| Facility | | $2,748.18 | $2,748.18 | $2,748.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $463.03 / $890.58 / $1,619.49
| Professional | | $463.03 | $890.58 | $1,619.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $496.06 / $1,077.52 / $6,679.00
| Facility | | $496.06 | $1,077.52 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $548.15 / $686.92 / $948.22
| Professional | | $548.15 | $686.92 | $948.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $607.44 / $1,223.38 / $4,940.33
| Professional | | $607.44 | $1,223.38 | $4,940.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,685.00 / $4,249.00 / $16,394.00
| Facility | | $1,685.00 | $4,249.00 | $16,394.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $495.77 / $708.20 / $3,606.16
| Professional | | $495.77 | $708.20 | $3,606.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,685.00 / $4,249.00 / $10,216.29
| Facility | | $1,685.00 | $4,249.00 | $10,216.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $484.13 / $682.81 / $1,415.74
| Professional | | $484.13 | $682.81 | $1,415.74 |