- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,187.82 / $5,412.00 / $10,637.11
| Facility | | $1,187.82 | $5,412.00 | $10,637.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $618.48 / $716.81 / $1,046.98
| Professional | | $618.48 | $716.81 | $1,046.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,823.00 / $12,004.00 / $15,528.00
| Facility | | $9,823.00 | $12,004.00 | $15,528.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $636.16 / $813.51 / $1,344.97
| Professional | | $636.16 | $813.51 | $1,344.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $740.87 / $776.97 / $6,433.00
| Professional | | $740.87 | $776.97 | $6,433.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $778.19 / $778.19 / $900.00
| Facility | | $778.19 | $778.19 | $900.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $665.33 / $890.98 / $1,486.34
| Professional | | $665.33 | $890.98 | $1,486.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $657.24 / $841.91 / $994.98
| Professional | | $657.24 | $841.91 | $994.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $709.46 / $899.86 / $1,326.00
| Facility | | $709.46 | $899.86 | $1,326.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $832.00 / $954.87 / $1,319.00
| Professional | | $832.00 | $954.87 | $1,319.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $658.37 / $854.42 / $2,953.73
| Facility | | $658.37 | $854.42 | $2,953.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $658.37 / $854.42 / $2,953.73
| Professional | | $658.37 | $854.42 | $2,953.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,121.00 / $9,270.00 / $17,192.00
| Facility | | $5,121.00 | $9,270.00 | $17,192.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $522.87 / $821.55 / $1,306.60
| Professional | | $522.87 | $821.55 | $1,306.60 |