- 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
- $415.54 / $459.83 / $661.30
| Professional | | $415.54 | $459.83 | $661.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $977.96 / $3,764.00 / $9,039.00
| Facility | | $977.96 | $3,764.00 | $9,039.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $356.58 / $583.77 / $2,981.36
| Professional | | $356.58 | $583.77 | $2,981.36 |
- 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
- $390.00 / $735.52 / $1,339.31
| Professional | | $390.00 | $735.52 | $1,339.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $409.83 / $889.92 / $6,679.00
| Facility | | $409.83 | $889.92 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $452.86 / $567.32 / $783.13
| Professional | | $452.86 | $567.32 | $783.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $501.76 / $1,010.54 / $3,833.81
| Professional | | $501.76 | $1,010.54 | $3,833.81 |
- 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
- $418.40 / $592.72 / $2,981.36
| Professional | | $418.40 | $592.72 | $2,981.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,685.00 / $3,997.00 / $9,039.00
| Facility | | $1,685.00 | $3,997.00 | $9,039.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $410.90 / $541.40 / $1,249.68
| Professional | | $410.90 | $541.40 | $1,249.68 |