- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,015.64 / $4,771.00 / $9,539.00
| Facility | | $1,015.64 | $4,771.00 | $9,539.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $898.07 / $1,015.64 / $1,483.94
| Professional | | $898.07 | $1,015.64 | $1,483.94 |
- 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
- $840.13 / $1,069.64 / $1,490.87
| Professional | | $840.13 | $1,069.64 | $1,490.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $778.00 / $1,010.85 / $1,982.53
| Professional | | $778.00 | $1,010.85 | $1,982.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $929.74 / $1,298.08 / $2,137.60
| Professional | | $929.74 | $1,298.08 | $2,137.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $860.78 / $1,032.94 / $1,273.95
| Professional | | $860.78 | $1,032.94 | $1,273.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,015.64 / $1,294.60 / $1,948.40
| Facility | | $1,015.64 | $1,294.60 | $1,948.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,200.00 / $1,342.69 / $2,118.77
| Professional | | $1,200.00 | $1,342.69 | $2,118.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $953.43 / $1,334.00 / $7,420.00
| Facility | | $953.43 | $1,334.00 | $7,420.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $953.43 / $1,334.00 / $7,420.00
| Professional | | $953.43 | $1,334.00 | $7,420.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,737.00 / $9,373.00 / $17,192.00
| Facility | | $5,737.00 | $9,373.00 | $17,192.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $823.63 / $1,311.90 / $2,042.83
| Professional | | $823.63 | $1,311.90 | $2,042.83 |