- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,748.64 / $6,827.70 / $15,742.00
| Facility | | $1,748.64 | $6,827.70 | $15,742.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $863.37 / $1,137.08 / $1,505.43
| Professional | | $863.37 | $1,137.08 | $1,505.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,153.00 / $7,363.00 / $9,410.00
| Facility | | $6,153.00 | $7,363.00 | $9,410.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $919.22 / $1,190.40 / $1,632.63
| Professional | | $919.22 | $1,190.40 | $1,632.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,079.30 / $1,094.59 / $7,369.00
| Professional | | $1,079.30 | $1,094.59 | $7,369.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,137.90 / $1,137.90 / $1,137.90
| Facility | | $1,137.90 | $1,137.90 | $1,137.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $957.31 / $1,167.83 / $2,003.55
| Professional | | $957.31 | $1,167.83 | $2,003.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,058.90 / $1,171.33 / $1,394.45
| Professional | | $1,058.90 | $1,171.33 | $1,394.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $966.53 / $1,189.74 / $1,700.30
| Facility | | $966.53 | $1,189.74 | $1,700.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,200.00 / $1,381.00 / $2,232.00
| Professional | | $1,200.00 | $1,381.00 | $2,232.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $962.64 / $1,260.75 / $9,040.00
| Facility | | $962.64 | $1,260.75 | $9,040.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $962.64 / $1,260.75 / $9,040.00
| Professional | | $962.64 | $1,260.75 | $9,040.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,693.00 / $11,671.00 / $21,639.00
| Facility | | $6,693.00 | $11,671.00 | $21,639.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $729.47 / $1,046.76 / $1,825.93
| Professional | | $729.47 | $1,046.76 | $1,825.93 |