- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,014.72 / $4,771.00 / $9,539.00
| Facility | | $1,014.72 | $4,771.00 | $9,539.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $834.16 / $941.14 / $1,196.74
| Professional | | $834.16 | $941.14 | $1,196.74 |
- 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
- $833.47 / $1,065.82 / $1,762.12
| Professional | | $833.47 | $1,065.82 | $1,762.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $916.00 / $1,068.36 / $2,019.22
| Professional | | $916.00 | $1,068.36 | $2,019.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $900.00 / $900.00 / $1,017.38
| Facility | | $900.00 | $900.00 | $1,017.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $865.85 / $1,114.56 / $1,989.09
| Professional | | $865.85 | $1,114.56 | $1,989.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $860.70 / $1,101.70 / $1,296.00
| Professional | | $860.70 | $1,101.70 | $1,296.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $927.22 / $1,190.85 / $1,761.91
| Facility | | $927.22 | $1,190.85 | $1,761.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,116.00 / $1,270.00 / $1,748.00
| Professional | | $1,116.00 | $1,270.00 | $1,748.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $848.97 / $1,146.57 / $3,953.34
| Facility | | $848.97 | $1,146.57 | $3,953.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $848.97 / $1,146.57 / $3,953.34
| Professional | | $848.97 | $1,146.57 | $3,953.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,423.00 / $11,475.00 / $21,639.00
| Facility | | $6,423.00 | $11,475.00 | $21,639.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $674.46 / $1,069.13 / $1,722.26
| Professional | | $674.46 | $1,069.13 | $1,722.26 |