- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,107.50 / $5,087.00 / $8,920.00
| Facility | | $1,107.50 | $5,087.00 | $8,920.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $916.79 / $1,017.40 / $1,399.67
| Professional | | $916.79 | $1,017.40 | $1,399.67 |
- 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
- $886.42 / $1,147.56 / $1,897.26
| Professional | | $886.42 | $1,147.56 | $1,897.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $966.41 / $1,073.18 / $2,012.00
| Professional | | $966.41 | $1,073.18 | $2,012.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $640.00 / $640.00 / $1,115.95
| Facility | | $640.00 | $640.00 | $1,115.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $946.17 / $1,305.56 / $2,175.42
| Professional | | $946.17 | $1,305.56 | $2,175.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $911.49 / $1,166.71 / $1,367.15
| Professional | | $911.49 | $1,166.71 | $1,367.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $995.97 / $1,301.66 / $1,825.14
| Facility | | $995.97 | $1,301.66 | $1,825.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,200.00 / $1,332.00 / $2,238.10
| Professional | | $1,200.00 | $1,332.00 | $2,238.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $985.90 / $1,291.48 / $3,512.00
| Facility | | $985.90 | $1,291.48 | $3,512.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $985.90 / $1,291.48 / $3,512.00
| Professional | | $985.90 | $1,291.48 | $3,512.00 |
- 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
- $816.29 / $1,213.68 / $1,882.51
| Professional | | $816.29 | $1,213.68 | $1,882.51 |