- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,194.18 / $5,360.00 / $9,347.59
| Facility | | $1,194.18 | $5,360.00 | $9,347.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $586.47 / $682.54 / $1,023.46
| Professional | | $586.47 | $682.54 | $1,023.46 |
- 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
- $634.26 / $823.34 / $1,361.22
| Professional | | $634.26 | $823.34 | $1,361.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $673.81 / $754.67 / $6,433.00
| Professional | | $673.81 | $754.67 | $6,433.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $776.00 / $776.00 / $781.05
| Facility | | $776.00 | $776.00 | $781.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $636.23 / $853.00 / $1,448.93
| Professional | | $636.23 | $853.00 | $1,448.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $659.74 / $853.79 / $1,009.02
| Professional | | $659.74 | $853.79 | $1,009.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $651.51 / $808.23 / $1,249.05
| Facility | | $651.51 | $808.23 | $1,249.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $764.00 / $885.28 / $1,293.00
| Professional | | $764.00 | $885.28 | $1,293.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $629.16 / $836.92 / $1,726.32
| Facility | | $629.16 | $836.92 | $1,726.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $629.16 / $836.92 / $1,726.32
| Professional | | $629.16 | $836.92 | $1,726.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,713.00 / $2,863.00 / $5,340.00
| Facility | | $1,713.00 | $2,863.00 | $5,340.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $488.72 / $781.96 / $1,201.30
| Professional | | $488.72 | $781.96 | $1,201.30 |