- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $556.51 / $2,071.00 / $9,233.53
| Facility | | $556.51 | $2,071.00 | $9,233.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $361.64 / $564.58 / $1,055.69
| Professional | | $361.64 | $564.58 | $1,055.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,712.00 / $3,264.00 / $14,996.00
| Facility | | $1,712.00 | $3,264.00 | $14,996.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $388.75 / $590.52 / $1,061.88
| Professional | | $388.75 | $590.52 | $1,061.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $392.41 / $490.51 / $571.72
| Facility | | $392.41 | $490.51 | $571.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $605.33 / $804.25 / $981.14
| Professional | | $605.33 | $804.25 | $981.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21,571.00 / $21,571.00 / $21,571.00
| Facility | | $21,571.00 | $21,571.00 | $21,571.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $375.24 / $625.52 / $1,085.98
| Professional | | $375.24 | $625.52 | $1,085.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,848.74 / $2,848.74 / $4,535.89
| Facility | | $2,848.74 | $2,848.74 | $4,535.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $412.03 / $644.54 / $1,052.16
| Professional | | $412.03 | $644.54 | $1,052.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $515.21 / $710.00 / $967.20
| Professional | | $515.21 | $710.00 | $967.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,020.00 / $1,940.00 / $4,132.00
| Facility | | $1,020.00 | $1,940.00 | $4,132.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $558.38 / $755.49 / $1,161.17
| Professional | | $558.38 | $755.49 | $1,161.17 |