- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,758.00 / $2,747.00 / $5,159.20
| Facility | | $1,758.00 | $2,747.00 | $5,159.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $434.01 / $581.39 / $1,941.92
| Professional | | $434.01 | $581.39 | $1,941.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $941.10 / $3,133.00 / $8,498.00
| Facility | | $941.10 | $3,133.00 | $8,498.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $504.37 / $957.09 / $4,977.24
| Professional | | $504.37 | $957.09 | $4,977.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $588.54 / $909.67 / $1,232.29
| Professional | | $588.54 | $909.67 | $1,232.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $554.13 / $821.83 / $1,326.97
| Professional | | $554.13 | $821.83 | $1,326.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $469.28 / $1,011.46 / $6,679.00
| Facility | | $469.28 | $1,011.46 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $538.50 / $652.29 / $890.08
| Professional | | $538.50 | $652.29 | $890.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $583.67 / $1,157.08 / $1,526.38
| Professional | | $583.67 | $1,157.08 | $1,526.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,640.00 / $3,592.00 / $26,542.00
| Facility | | $1,640.00 | $3,592.00 | $26,542.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $576.41 / $1,054.89 / $4,977.24
| Professional | | $576.41 | $1,054.89 | $4,977.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,640.00 / $3,372.00 / $8,425.00
| Facility | | $1,640.00 | $3,372.00 | $8,425.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $525.64 / $907.19 / $1,389.19
| Professional | | $525.64 | $907.19 | $1,389.19 |