- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,392.98 / $5,360.00 / $9,539.00
| Facility | | $1,392.98 | $5,360.00 | $9,539.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $714.42 / $837.81 / $1,130.08
| Professional | | $714.42 | $837.81 | $1,130.08 |
- 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
- $744.65 / $952.24 / $1,574.33
| Professional | | $744.65 | $952.24 | $1,574.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $837.69 / $908.60 / $7,889.00
| Professional | | $837.69 | $908.60 | $7,889.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $776.00 / $776.00 / $909.88
| Facility | | $776.00 | $776.00 | $909.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $776.35 / $1,004.27 / $1,742.84
| Professional | | $776.35 | $1,004.27 | $1,742.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $768.34 / $983.48 / $1,162.19
| Professional | | $768.34 | $983.48 | $1,162.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $826.59 / $1,054.38 / $1,563.94
| Facility | | $826.59 | $1,054.38 | $1,563.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $964.00 / $1,117.28 / $1,539.00
| Professional | | $964.00 | $1,117.28 | $1,539.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $770.32 / $1,014.99 / $3,463.75
| Facility | | $770.32 | $1,014.99 | $3,463.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $770.32 / $1,014.99 / $3,463.75
| Professional | | $770.32 | $1,014.99 | $3,463.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,408.00 / $13,296.00 / $26,537.00
| Facility | | $7,408.00 | $13,296.00 | $26,537.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $613.10 / $950.09 / $1,527.80
| Professional | | $613.10 | $950.09 | $1,527.80 |