- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,047.13 / $5,370.32 / $8,511.38
| Facility | | $1,047.13 | $5,370.32 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $489.78 / $588.84 / $1,445.44
| Professional | | $489.78 | $588.84 | $1,445.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,456.54 / $7,585.78 / $57,543.99
| Facility | | $6,456.54 | $7,585.78 | $57,543.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $478.63 / $707.95 / $1,000.00
| Professional | | $478.63 | $707.95 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $478.63 / $691.83 / $1,096.48
| Professional | | $478.63 | $691.83 | $1,096.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $549.54 / $707.95 / $776.25
| Professional | | $549.54 | $707.95 | $776.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $501.19 / $676.08 / $1,023.29
| Professional | | $501.19 | $676.08 | $1,023.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,023.29 / $4,570.88 / $8,511.38
| Facility | | $1,023.29 | $4,570.88 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $524.81 / $676.08 / $1,778.28
| Professional | | $524.81 | $676.08 | $1,778.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,096.48 / $1,096.48 / $1,096.48
| Facility | | $1,096.48 | $1,096.48 | $1,096.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $676.08 / $954.99 / $1,174.90
| Professional | | $676.08 | $954.99 | $1,174.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $309.03 / $537.03 / $630.96
| Facility | | $309.03 | $537.03 | $630.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $309.03 / $537.03 / $630.96
| Professional | | $309.03 | $537.03 | $630.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,089.30 / $3,981.07 / $21,877.62
| Facility | | $2,089.30 | $3,981.07 | $21,877.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $457.09 / $602.56 / $1,096.48
| Professional | | $457.09 | $602.56 | $1,096.48 |