- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,131.72 / $5,360.00 / $9,975.00
| Facility | | $1,131.72 | $5,360.00 | $9,975.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $919.59 / $1,082.89 / $1,256.09
| Professional | | $919.59 | $1,082.89 | $1,256.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,032.00 / $6,548.00 / $7,221.00
| Facility | | $5,032.00 | $6,548.00 | $7,221.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $960.25 / $1,246.20 / $1,721.56
| Professional | | $960.25 | $1,246.20 | $1,721.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,079.81 / $1,079.81 / $9,211.00
| Professional | | $1,079.81 | $1,079.81 | $9,211.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,199.65 / $1,199.65 / $1,199.65
| Facility | | $1,199.65 | $1,199.65 | $1,199.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $938.11 / $1,152.26 / $2,110.90
| Professional | | $938.11 | $1,152.26 | $2,110.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,116.86 / $1,237.83 / $1,473.61
| Professional | | $1,116.86 | $1,237.83 | $1,473.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $919.59 / $1,183.15 / $1,695.49
| Facility | | $919.59 | $1,183.15 | $1,695.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,195.00 / $1,393.00 / $2,457.00
| Professional | | $1,195.00 | $1,393.00 | $2,457.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $947.74 / $1,257.71 / $7,030.19
| Facility | | $947.74 | $1,257.71 | $7,030.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $947.74 / $1,257.71 / $7,030.19
| Professional | | $947.74 | $1,257.71 | $7,030.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,303.00 / $9,270.00 / $17,192.00
| Facility | | $6,303.00 | $9,270.00 | $17,192.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $726.64 / $1,017.29 / $1,856.83
| Professional | | $726.64 | $1,017.29 | $1,856.83 |