- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,040.77 / $3,438.93 / $8,294.00
| Facility | | $1,040.77 | $3,438.93 | $8,294.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $783.51 / $949.62 / $1,849.57
| Professional | | $783.51 | $949.62 | $1,849.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,060.00 / $3,693.00 / $4,290.00
| Facility | | $3,060.00 | $3,693.00 | $4,290.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $802.88 / $1,066.99 / $1,503.40
| Professional | | $802.88 | $1,066.99 | $1,503.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $886.98 / $901.92 / $2,413.00
| Professional | | $886.98 | $901.92 | $2,413.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,422.45 / $1,422.45 / $1,422.45
| Facility | | $1,422.45 | $1,422.45 | $1,422.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $809.97 / $1,085.50 / $1,909.11
| Professional | | $809.97 | $1,085.50 | $1,909.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,067.88 / $1,188.06 / $1,414.36
| Professional | | $1,067.88 | $1,188.06 | $1,414.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $796.25 / $1,076.59 / $1,509.12
| Facility | | $796.25 | $1,076.59 | $1,509.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,186.00 / $1,432.00 / $2,006.00
| Professional | | $1,186.00 | $1,432.00 | $2,006.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $813.38 / $1,104.01 / $3,440.00
| Facility | | $813.38 | $1,104.01 | $3,440.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $913.86 / $1,244.16 / $3,440.00
| Professional | | $913.86 | $1,244.16 | $3,440.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,911.00 / $3,175.00 / $5,340.00
| Facility | | $1,911.00 | $3,175.00 | $5,340.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $744.50 / $1,000.68 / $1,630.82
| Professional | | $744.50 | $1,000.68 | $1,630.82 |