- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,047.13 / $4,786.30 / $8,317.64
| Facility | | $1,047.13 | $4,786.30 | $8,317.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $870.96 / $1,047.13 / $1,905.46
| Professional | | $870.96 | $1,047.13 | $1,905.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,344.23 / $2,570.40 / $57,543.99
| Facility | | $2,344.23 | $2,570.40 | $57,543.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $954.99 / $1,000.00 / $1,737.80
| Professional | | $954.99 | $1,000.00 | $1,737.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $549.54 / $549.54 / $549.54
| Facility | | $549.54 | $549.54 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $758.58 / $1,023.29 / $1,737.80
| Professional | | $758.58 | $1,023.29 | $1,737.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $239.88 / $933.25 / $1,412.54
| Professional | | $239.88 | $933.25 | $1,412.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $812.83 / $912.01 / $1,548.82
| Professional | | $812.83 | $912.01 | $1,548.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,023.29 / $3,801.89 / $8,317.64
| Facility | | $1,023.29 | $3,801.89 | $8,317.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $891.25 / $1,174.90 / $3,090.30
| Professional | | $891.25 | $1,174.90 | $3,090.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,000.00 / $1,000.00 / $1,737.80
| Professional | | $1,000.00 | $1,000.00 | $1,737.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $478.63 / $478.63 / $933.25
| Facility | | $478.63 | $478.63 | $933.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $478.63 / $478.63 / $954.99
| Professional | | $478.63 | $478.63 | $954.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $223.87 / $1,548.82 / $7,079.46
| Facility | | $223.87 | $1,548.82 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $758.58 / $1,023.29 / $1,737.80
| Professional | | $758.58 | $1,023.29 | $1,737.80 |