- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,092.86 / $3,278.00 / $10,268.00
| Facility | | $1,092.86 | $3,278.00 | $10,268.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $706.53 / $769.87 / $1,359.06
| Professional | | $706.53 | $769.87 | $1,359.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $918.00 / $2,443.00 / $8,800.00
| Facility | | $918.00 | $2,443.00 | $8,800.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $588.17 / $798.03 / $1,343.54
| Professional | | $588.17 | $798.03 | $1,343.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $698.03 / $837.64 / $1,036.76
| Facility | | $698.03 | $837.64 | $1,036.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $593.79 / $767.83 / $907.44
| Professional | | $593.79 | $767.83 | $907.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $508.00 / $850.77 / $1,337.58
| Facility | | $508.00 | $850.77 | $1,337.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $595.85 / $972.72 / $1,476.49
| Professional | | $595.85 | $972.72 | $1,476.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $508.00 / $850.77 / $996.44
| Facility | | $508.00 | $850.77 | $996.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $634.46 / $977.24 / $1,476.49
| Professional | | $634.46 | $977.24 | $1,476.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $72.25 / $682.65 / $1,021.86
| Professional | | $72.25 | $682.65 | $1,021.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $675.00 / $2,499.00 / $5,235.00
| Facility | | $675.00 | $2,499.00 | $5,235.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $626.51 / $882.27 / $1,529.41
| Professional | | $626.51 | $882.27 | $1,529.41 |