- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,150.42 / $2,663.12 / $6,923.44
| Facility | | $1,150.42 | $2,663.12 | $6,923.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $663.34 / $858.36 / $2,271.09
| Professional | | $663.34 | $858.36 | $2,271.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,313.00 / $3,715.00 / $13,940.55
| Facility | | $1,313.00 | $3,715.00 | $13,940.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $794.33 / $1,331.24 / $5,736.48
| Professional | | $794.33 | $1,331.24 | $5,736.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,051.73 / $1,559.43 / $2,112.48
| Professional | | $1,051.73 | $1,559.43 | $2,112.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $813.42 / $1,261.06 / $2,232.62
| Professional | | $813.42 | $1,261.06 | $2,232.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $798.20 / $1,733.92 / $6,679.00
| Facility | | $798.20 | $1,733.92 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $915.93 / $1,109.50 / $1,525.85
| Professional | | $915.93 | $1,109.50 | $1,525.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $989.59 / $1,961.76 / $2,587.88
| Professional | | $989.59 | $1,961.76 | $2,587.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,201.76 / $4,139.10 / $6,468.05
| Facility | | $2,201.76 | $4,139.10 | $6,468.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,236.20 / $2,447.89 / $5,831.00
| Professional | | $1,236.20 | $2,447.89 | $5,831.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,902.00 / $3,997.00 / $16,394.00
| Facility | | $1,902.00 | $3,997.00 | $16,394.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $839.27 / $1,408.84 / $5,736.48
| Professional | | $839.27 | $1,408.84 | $5,736.48 |
- 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
- $798.44 / $1,213.74 / $2,498.92
| Professional | | $798.44 | $1,213.74 | $2,498.92 |