- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,013.00 / $6,012.00 / $17,700.77
| Facility | | $1,013.00 | $6,012.00 | $17,700.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $759.86 / $903.99 / $1,904.36
| Professional | | $759.86 | $903.99 | $1,904.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,639.91 / $11,851.00 / $28,970.26
| Facility | | $8,639.91 | $11,851.00 | $28,970.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $871.15 / $1,375.18 / $1,805.52
| Professional | | $871.15 | $1,375.18 | $1,805.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $809.23 / $1,109.49 / $1,819.30
| Professional | | $809.23 | $1,109.49 | $1,819.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,044.19 / $1,385.41 / $1,402.73
| Professional | | $1,044.19 | $1,385.41 | $1,402.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,471.91 / $12,495.40 / $26,515.87
| Facility | | $5,471.91 | $12,495.40 | $26,515.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,240.97 / $5,724.00 / $14,043.94
| Facility | | $1,240.97 | $5,724.00 | $14,043.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $797.99 / $1,139.02 / $2,610.92
| Professional | | $797.99 | $1,139.02 | $2,610.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.00 / $950.70 / $2,349.69
| Professional | | $5.00 | $950.70 | $2,349.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $854.08 / $1,148.45 / $1,838.68
| Professional | | $854.08 | $1,148.45 | $1,838.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $873.56 / $873.56 / $941.40
| Facility | | $873.56 | $873.56 | $941.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $854.10 / $873.56 / $941.40
| Professional | | $854.10 | $873.56 | $941.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,332.00 / $3,914.00 / $7,000.00
| Facility | | $2,332.00 | $3,914.00 | $7,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $741.57 / $1,082.74 / $1,704.34
| Professional | | $741.57 | $1,082.74 | $1,704.34 |