- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,924.00 / $2,747.00 / $7,252.23
| Facility | | $1,924.00 | $2,747.00 | $7,252.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $880.57 / $990.86 / $2,567.27
| Professional | | $880.57 | $990.86 | $2,567.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,079.00 / $4,599.05 / $13,483.66
| Facility | | $1,079.00 | $4,599.05 | $13,483.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $931.71 / $1,647.08 / $7,097.52
| Professional | | $931.71 | $1,647.08 | $7,097.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,284.86 / $1,905.12 / $2,580.78
| Professional | | $1,284.86 | $1,905.12 | $2,580.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $993.97 / $1,554.01 / $2,823.34
| Professional | | $993.97 | $1,554.01 | $2,823.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $981.92 / $1,909.00 / $7,218.72
| Facility | | $981.92 | $1,909.00 | $7,218.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,126.75 / $1,364.87 / $1,864.10
| Professional | | $1,126.75 | $1,364.87 | $1,864.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,225.52 / $2,429.46 / $3,204.86
| Professional | | $1,225.52 | $2,429.46 | $3,204.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $4,751.20 / $13,773.00
| Facility | | $55.00 | $4,751.20 | $13,773.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,022.42 / $1,801.39 / $7,097.52
| Professional | | $1,022.42 | $1,801.39 | $7,097.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,324.00 / $5,097.00 / $10,764.00
| Facility | | $2,324.00 | $5,097.00 | $10,764.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,013.62 / $1,483.92 / $2,880.03
| Professional | | $1,013.62 | $1,483.92 | $2,880.03 |