- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,883.56 / $2,747.00 / $5,039.00
| Facility | | $1,883.56 | $2,747.00 | $5,039.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $485.71 / $544.65 / $879.77
| Professional | | $485.71 | $544.65 | $879.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,061.00 / $3,715.00 / $9,039.00
| Facility | | $1,061.00 | $3,715.00 | $9,039.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $537.60 / $938.55 / $9,877.00
| Professional | | $537.60 | $938.55 | $9,877.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $744.76 / $1,104.21 / $1,495.91
| Professional | | $744.76 | $1,104.21 | $1,495.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $570.21 / $882.21 / $1,595.05
| Professional | | $570.21 | $882.21 | $1,595.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $565.85 / $1,227.83 / $6,679.00
| Facility | | $565.85 | $1,227.83 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $649.30 / $786.53 / $1,080.50
| Professional | | $649.30 | $786.53 | $1,080.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $702.46 / $1,392.56 / $1,837.00
| Professional | | $702.46 | $1,392.56 | $1,837.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,567.03 / $2,567.03 / $2,567.03
| Facility | | $2,567.03 | $2,567.03 | $2,567.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,902.00 / $3,997.00 / $26,542.00
| Facility | | $1,902.00 | $3,997.00 | $26,542.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $575.99 / $1,011.54 / $9,877.00
| Professional | | $575.99 | $1,011.54 | $9,877.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,902.00 / $3,764.00 / $8,766.00
| Facility | | $1,902.00 | $3,764.00 | $8,766.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $537.33 / $847.89 / $1,623.52
| Professional | | $537.33 | $847.89 | $1,623.52 |