- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,004.12 / $5,087.00 / $8,294.00
| Facility | | $1,004.12 | $5,087.00 | $8,294.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $834.39 / $990.82 / $1,259.02
| Professional | | $834.39 | $990.82 | $1,259.02 |
- 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
- $867.27 / $1,109.05 / $1,833.59
| Professional | | $867.27 | $1,109.05 | $1,833.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $986.80 / $1,073.86 / $5,113.00
| Professional | | $986.80 | $1,073.86 | $5,113.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $640.00 / $640.00 / $1,052.08
| Facility | | $640.00 | $640.00 | $1,052.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $895.36 / $1,204.31 / $2,023.63
| Professional | | $895.36 | $1,204.31 | $2,023.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $885.40 / $1,145.22 / $1,353.44
| Professional | | $885.40 | $1,145.22 | $1,353.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $948.93 / $1,174.82 / $1,808.34
| Facility | | $948.93 | $1,174.82 | $1,808.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,101.00 / $1,276.78 / $1,757.00
| Professional | | $1,101.00 | $1,276.78 | $1,757.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $900.53 / $1,180.24 / $3,955.46
| Facility | | $900.53 | $1,180.24 | $3,955.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $900.53 / $1,180.24 / $3,955.46
| Professional | | $900.53 | $1,180.24 | $3,955.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,121.00 / $9,270.00 / $17,192.00
| Facility | | $5,121.00 | $9,270.00 | $17,192.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $700.12 / $1,165.80 / $1,832.58
| Professional | | $700.12 | $1,165.80 | $1,832.58 |