- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,421.00 / $2,663.12 / $4,465.49
| Facility | | $1,421.00 | $2,663.12 | $4,465.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $688.12 / $798.41 / $1,405.08
| Professional | | $688.12 | $798.41 | $1,405.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,313.00 / $3,715.00 / $11,217.00
| Facility | | $1,313.00 | $3,715.00 | $11,217.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $792.22 / $1,379.91 / $5,973.60
| Professional | | $792.22 | $1,379.91 | $5,973.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,095.73 / $1,624.67 / $2,458.94
| Professional | | $1,095.73 | $1,624.67 | $2,458.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $793.78 / $1,297.94 / $2,336.28
| Professional | | $793.78 | $1,297.94 | $2,336.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $831.48 / $1,806.46 / $6,679.00
| Facility | | $831.48 | $1,806.46 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $954.12 / $1,155.76 / $1,589.68
| Professional | | $954.12 | $1,155.76 | $1,589.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,030.96 / $2,043.78 / $2,696.06
| Professional | | $1,030.96 | $2,043.78 | $2,696.06 |
- 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
- $852.89 / $1,524.94 / $5,973.60
| Professional | | $852.89 | $1,524.94 | $5,973.60 |
- 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
- $843.05 / $1,251.44 / $2,652.16
| Professional | | $843.05 | $1,251.44 | $2,652.16 |