- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,100.20 / $5,412.00 / $13,209.00
| Facility | | $1,100.20 | $5,412.00 | $13,209.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,000.01 / $1,100.20 / $1,544.93
| Professional | | $1,000.01 | $1,100.20 | $1,544.93 |
- 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
- $874.46 / $1,113.33 / $1,551.78
| Professional | | $874.46 | $1,113.33 | $1,551.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $778.00 / $1,158.21 / $2,258.51
| Professional | | $778.00 | $1,158.21 | $2,258.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $975.20 / $1,314.03 / $2,229.90
| Professional | | $975.20 | $1,314.03 | $2,229.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $896.06 / $1,075.27 / $1,326.17
| Professional | | $896.06 | $1,075.27 | $1,326.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,100.20 / $1,352.89 / $2,013.37
| Facility | | $1,100.20 | $1,352.89 | $2,013.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,318.00 / $1,498.18 / $2,204.52
| Professional | | $1,318.00 | $1,498.18 | $2,204.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $998.10 / $1,350.88 / $7,420.00
| Facility | | $998.10 | $1,350.88 | $7,420.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $998.10 / $1,350.88 / $7,420.00
| Professional | | $998.10 | $1,350.88 | $7,420.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,303.00 / $9,373.00 / $17,192.00
| Facility | | $6,303.00 | $9,373.00 | $17,192.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $858.21 / $1,447.20 / $2,148.73
| Professional | | $858.21 | $1,447.20 | $2,148.73 |