- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,218.15 / $5,040.00 / $10,637.11
| Facility | | $1,218.15 | $5,040.00 | $10,637.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $634.55 / $733.96 / $979.35
| Professional | | $634.55 | $733.96 | $979.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,032.00 / $6,548.00 / $7,221.00
| Facility | | $5,032.00 | $6,548.00 | $7,221.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $651.53 / $833.16 / $1,377.46
| Professional | | $651.53 | $833.16 | $1,377.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $759.07 / $795.41 / $1,434.64
| Professional | | $759.07 | $795.41 | $1,434.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $795.31 / $795.31 / $900.00
| Facility | | $795.31 | $795.31 | $900.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $688.62 / $913.83 / $1,524.26
| Professional | | $688.62 | $913.83 | $1,524.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $671.83 / $860.00 / $1,016.37
| Professional | | $671.83 | $860.00 | $1,016.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $722.78 / $904.69 / $1,341.04
| Facility | | $722.78 | $904.69 | $1,341.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $853.00 / $979.34 / $1,350.00
| Professional | | $853.00 | $979.34 | $1,350.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $674.26 / $884.41 / $3,029.15
| Facility | | $674.26 | $884.41 | $3,029.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $674.26 / $884.41 / $3,029.15
| Professional | | $674.26 | $884.41 | $3,029.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,121.00 / $8,621.00 / $17,192.00
| Facility | | $5,121.00 | $8,621.00 | $17,192.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $566.50 / $915.53 / $1,296.67
| Professional | | $566.50 | $915.53 | $1,296.67 |