- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,066.25 / $5,091.00 / $10,767.00
| Facility | | $1,066.25 | $5,091.00 | $10,767.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $913.80 / $1,065.60 / $1,321.22
| Professional | | $913.80 | $1,065.60 | $1,321.22 |
- 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
- $858.05 / $1,097.26 / $1,504.89
| Professional | | $858.05 | $1,097.26 | $1,504.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $794.00 / $1,032.45 / $2,013.28
| Professional | | $794.00 | $1,032.45 | $2,013.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $944.43 / $1,259.35 / $2,333.52
| Professional | | $944.43 | $1,259.35 | $2,333.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $889.04 / $1,066.84 / $1,315.78
| Professional | | $889.04 | $1,066.84 | $1,315.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,008.11 / $1,307.80 / $1,918.57
| Facility | | $1,008.11 | $1,307.80 | $1,918.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,205.00 / $1,325.00 / $2,181.42
| Professional | | $1,205.00 | $1,325.00 | $2,181.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $967.77 / $1,259.18 / $6,585.00
| Facility | | $967.77 | $1,259.18 | $6,585.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $967.77 / $1,259.18 / $6,585.00
| Professional | | $967.77 | $1,259.18 | $6,585.00 |
- 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
- $801.27 / $1,298.80 / $2,062.92
| Professional | | $801.27 | $1,298.80 | $2,062.92 |