- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,287.96 / $5,480.00 / $14,798.00
| Facility | | $1,287.96 | $5,480.00 | $14,798.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $665.21 / $774.50 / $1,044.26
| Professional | | $665.21 | $774.50 | $1,044.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,153.00 / $7,363.00 / $9,410.00
| Facility | | $6,153.00 | $7,363.00 | $9,410.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $685.33 / $876.39 / $1,448.93
| Professional | | $685.33 | $876.39 | $1,448.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $788.33 / $835.04 / $6,898.00
| Professional | | $788.33 | $835.04 | $6,898.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $838.09 / $838.09 / $1,200.00
| Facility | | $838.09 | $838.09 | $1,200.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $709.09 / $906.97 / $1,630.51
| Professional | | $709.09 | $906.97 | $1,630.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $709.09 / $907.64 / $1,069.03
| Professional | | $709.09 | $907.64 | $1,069.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $760.38 / $974.04 / $1,449.94
| Facility | | $760.38 | $974.04 | $1,449.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $912.18 / $1,019.72 / $1,384.00
| Professional | | $912.18 | $1,019.72 | $1,384.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $690.52 / $921.83 / $3,240.37
| Facility | | $690.52 | $921.83 | $3,240.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $690.52 / $921.83 / $3,240.37
| Professional | | $690.52 | $921.83 | $3,240.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,651.00 / $6,870.00 / $12,739.00
| Facility | | $3,651.00 | $6,870.00 | $12,739.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $579.41 / $928.10 / $1,470.14
| Professional | | $579.41 | $928.10 | $1,470.14 |