- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,089.48 / $5,282.00 / $10,637.11
| Facility | | $1,089.48 | $5,282.00 | $10,637.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $849.44 / $991.31 / $1,258.98
| Professional | | $849.44 | $991.31 | $1,258.98 |
- 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
- $833.58 / $1,071.71 / $1,526.34
| Professional | | $833.58 | $1,071.71 | $1,526.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $982.59 / $1,006.02 / $2,022.10
| Professional | | $982.59 | $1,006.02 | $2,022.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $610.00 / $1,142.00 / $3,282.37
| Facility | | $610.00 | $1,142.00 | $3,282.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $764.84 / $1,154.19 / $1,943.57
| Professional | | $764.84 | $1,154.19 | $1,943.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $857.93 / $1,059.80 / $1,562.04
| Professional | | $857.93 | $1,059.80 | $1,562.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $923.87 / $1,177.50 / $1,825.03
| Facility | | $923.87 | $1,177.50 | $1,825.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,135.00 / $1,294.00 / $2,130.82
| Professional | | $1,135.00 | $1,294.00 | $2,130.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $899.90 / $1,169.65 / $2,098.11
| Facility | | $899.90 | $1,169.65 | $2,098.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $899.90 / $1,169.65 / $2,098.11
| Professional | | $899.90 | $1,169.65 | $2,098.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,745.00 / $10,466.00 / $21,401.00
| Facility | | $1,745.00 | $10,466.00 | $21,401.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $722.67 / $1,130.47 / $1,739.36
| Professional | | $722.67 | $1,130.47 | $1,739.36 |