- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,244.00 / $5,087.00 / $8,294.00
| Facility | | $1,244.00 | $5,087.00 | $8,294.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $933.07 / $1,012.37 / $1,492.28
| Professional | | $933.07 | $1,012.37 | $1,492.28 |
- 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
- $900.77 / $1,151.88 / $1,904.40
| Professional | | $900.77 | $1,151.88 | $1,904.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,052.95 / $1,095.96 / $6,433.00
| Professional | | $1,052.95 | $1,095.96 | $6,433.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $640.00 / $640.00 / $1,098.84
| Facility | | $640.00 | $640.00 | $1,098.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $955.88 / $1,363.01 / $2,123.73
| Professional | | $955.88 | $1,363.01 | $2,123.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $927.52 / $1,187.23 / $1,399.50
| Professional | | $927.52 | $1,187.23 | $1,399.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,012.37 / $1,308.67 / $1,987.97
| Facility | | $1,012.37 | $1,308.67 | $1,987.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,204.00 / $1,406.48 / $1,874.00
| Professional | | $1,204.00 | $1,406.48 | $1,874.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $965.54 / $1,299.30 / $4,134.05
| Facility | | $965.54 | $1,299.30 | $4,134.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $965.54 / $1,299.30 / $4,134.05
| Professional | | $965.54 | $1,299.30 | $4,134.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,408.00 / $13,296.00 / $26,537.00
| Facility | | $7,408.00 | $13,296.00 | $26,537.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $807.41 / $1,315.75 / $2,043.32
| Professional | | $807.41 | $1,315.75 | $2,043.32 |