- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,749.00 / $5,412.00 / $11,350.75
| Facility | | $1,749.00 | $5,412.00 | $11,350.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $923.30 / $1,093.49 / $1,604.85
| Professional | | $923.30 | $1,093.49 | $1,604.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,032.00 / $6,548.00 / $7,221.00
| Facility | | $5,032.00 | $6,548.00 | $7,221.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $951.23 / $1,243.45 / $2,055.79
| Professional | | $951.23 | $1,243.45 | $2,055.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,142.99 / $1,142.99 / $4,646.00
| Professional | | $1,142.99 | $1,142.99 | $4,646.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $900.00 / $900.00 / $1,187.74
| Facility | | $900.00 | $900.00 | $1,187.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $892.18 / $1,232.00 / $2,281.87
| Professional | | $892.18 | $1,232.00 | $2,281.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,002.67 / $1,283.42 / $1,515.14
| Professional | | $1,002.67 | $1,283.42 | $1,515.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $991.47 / $1,312.71 / $1,924.89
| Facility | | $991.47 | $1,312.71 | $1,924.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,248.00 / $1,403.00 / $1,942.00
| Professional | | $1,248.00 | $1,403.00 | $1,942.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $926.53 / $1,253.33 / $2,486.08
| Facility | | $926.53 | $1,253.33 | $2,486.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $926.53 / $1,253.33 / $2,486.08
| Professional | | $926.53 | $1,253.33 | $2,486.08 |
- 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
- $770.74 / $1,253.33 / $2,001.58
| Professional | | $770.74 | $1,253.33 | $2,001.58 |