- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,121.68 / $6,519.00 / $9,371.58
| Facility | | $1,121.68 | $6,519.00 | $9,371.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $682.71 / $829.76 / $2,112.84
| Professional | | $682.71 | $829.76 | $2,112.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $823.04 / $823.04 / $823.04
| Professional | | $823.04 | $823.04 | $823.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,015.30 / $2,015.30 / $2,044.70
| Facility | | $2,015.30 | $2,015.30 | $2,044.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $853.88 / $1,380.36 / $1,977.53
| Professional | | $853.88 | $1,380.36 | $1,977.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $530.04 / $530.04 / $6,025.59
| Facility | | $530.04 | $530.04 | $6,025.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $823.45 / $1,053.31 / $1,861.97
| Professional | | $823.45 | $1,053.31 | $1,861.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $775.95 / $1,019.37 / $1,544.40
| Facility | | $775.95 | $1,019.37 | $1,544.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $507.00 / $926.00 / $1,026.00
| Professional | | $507.00 | $926.00 | $1,026.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,047.40 / $1,155.63 / $1,314.45
| Professional | | $1,047.40 | $1,155.63 | $1,314.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,661.00 / $7,659.00 / $10,502.00
| Facility | | $1,661.00 | $7,659.00 | $10,502.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $641.92 / $890.23 / $1,849.17
| Professional | | $641.92 | $890.23 | $1,849.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,964.88 / $17,381.18 / $19,913.50
| Facility | | $2,964.88 | $17,381.18 | $19,913.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,736.48 / $5,736.48 / $6,831.30
| Professional | | $5,736.48 | $5,736.48 | $6,831.30 |