- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,637.18 / $5,040.00 / $10,637.11
| Facility | | $1,637.18 | $5,040.00 | $10,637.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $859.16 / $982.57 / $1,320.37
| Professional | | $859.16 | $982.57 | $1,320.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,900.00 / $13,875.00 / $15,752.00
| Facility | | $10,900.00 | $13,875.00 | $15,752.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $873.72 / $1,117.30 / $1,847.23
| Professional | | $873.72 | $1,117.30 | $1,847.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $983.23 / $1,063.48 / $7,889.00
| Professional | | $983.23 | $1,063.48 | $7,889.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $640.00 / $640.00 / $1,066.85
| Facility | | $640.00 | $640.00 | $1,066.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $920.00 / $1,202.64 / $2,055.57
| Professional | | $920.00 | $1,202.64 | $2,055.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $900.37 / $1,152.47 / $1,359.36
| Professional | | $900.37 | $1,152.47 | $1,359.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $977.48 / $1,240.29 / $1,798.10
| Facility | | $977.48 | $1,240.29 | $1,798.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,166.00 / $1,310.00 / $1,789.00
| Professional | | $1,166.00 | $1,310.00 | $1,789.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $890.85 / $1,193.01 / $4,085.53
| Facility | | $890.85 | $1,193.01 | $4,085.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $890.85 / $1,193.01 / $4,085.53
| Professional | | $890.85 | $1,193.01 | $4,085.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,621.00 / $20,974.00 / $40,876.00
| Facility | | $7,621.00 | $20,974.00 | $40,876.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $726.68 / $1,157.93 / $1,800.88
| Professional | | $726.68 | $1,157.93 | $1,800.88 |