- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,234.67 / $7,074.00 / $20,400.00
| Facility | | $1,234.67 | $7,074.00 | $20,400.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $514.38 / $793.27 / $1,980.72
| Professional | | $514.38 | $793.27 | $1,980.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $842.00 / $842.00 / $842.00
| Facility | | $842.00 | $842.00 | $842.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $718.89 / $1,179.97 / $1,823.16
| Professional | | $718.89 | $1,179.97 | $1,823.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,172.76 / $1,373.68 / $1,648.03
| Professional | | $1,172.76 | $1,373.68 | $1,648.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $793.27 / $1,154.66 / $1,490.68
| Facility | | $793.27 | $1,154.66 | $1,490.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $925.28 / $1,100.50 / $1,665.50
| Professional | | $925.28 | $1,100.50 | $1,665.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $728.14 / $1,103.49 / $1,265.63
| Facility | | $728.14 | $1,103.49 | $1,265.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $829.81 / $1,211.09 / $5,217.00
| Facility | | $829.81 | $1,211.09 | $5,217.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,029.75 / $1,255.38 / $1,723.31
| Professional | | $1,029.75 | $1,255.38 | $1,723.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,715.78 / $10,171.54 / $12,117.15
| Facility | | $7,715.78 | $10,171.54 | $12,117.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,150.10 / $1,474.36 / $1,981.56
| Professional | | $1,150.10 | $1,474.36 | $1,981.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,912.00 / $17,192.00 / $22,956.00
| Facility | | $2,912.00 | $17,192.00 | $22,956.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $823.73 / $1,209.71 / $1,918.46
| Professional | | $823.73 | $1,209.71 | $1,918.46 |