- 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
- $440.02 / $509.89 / $701.85
| Professional | | $440.02 | $509.89 | $701.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,046.58 / $3,764.00 / $9,039.00
| Facility | | $1,046.58 | $3,764.00 | $9,039.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $381.60 / $619.64 / $4,005.00
| Professional | | $381.60 | $619.64 | $4,005.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $605.88 / $605.88 / $1,316.29
| Professional | | $605.88 | $605.88 | $1,316.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,346.32 / $1,346.32 / $1,346.32
| Facility | | $1,346.32 | $1,346.32 | $1,346.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $410.49 / $788.69 / $1,417.84
| Professional | | $410.49 | $788.69 | $1,417.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $440.19 / $954.26 / $6,679.00
| Facility | | $440.19 | $954.26 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $486.41 / $608.34 / $839.75
| Professional | | $486.41 | $608.34 | $839.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $539.85 / $1,087.26 / $3,618.15
| Professional | | $539.85 | $1,087.26 | $3,618.15 |
- 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
- $437.39 / $630.63 / $4,005.00
| Professional | | $437.39 | $630.63 | $4,005.00 |
- 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
- $434.77 / $588.42 / $1,295.64
| Professional | | $434.77 | $588.42 | $1,295.64 |