- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,244.00 / $5,087.00 / $8,294.00
| Facility | | $1,244.00 | $5,087.00 | $8,294.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $849.64 / $1,079.10 / $1,383.84
| Professional | | $849.64 | $1,079.10 | $1,383.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,060.00 / $3,693.00 / $4,290.00
| Facility | | $3,060.00 | $3,693.00 | $4,290.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $972.59 / $1,249.23 / $1,765.41
| Professional | | $972.59 | $1,249.23 | $1,765.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,119.73 / $2,183.46 / $4,284.00
| Professional | | $1,119.73 | $2,183.46 | $4,284.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,206.07 / $1,206.07 / $1,206.07
| Facility | | $1,206.07 | $1,206.07 | $1,206.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $924.89 / $1,278.79 / $2,025.24
| Professional | | $924.89 | $1,278.79 | $2,025.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,001.13 / $1,177.80 / $1,515.88
| Professional | | $1,001.13 | $1,177.80 | $1,515.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $975.24 / $1,286.78 / $1,945.07
| Facility | | $975.24 | $1,286.78 | $1,945.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,243.00 / $1,448.00 / $2,046.21
| Professional | | $1,243.00 | $1,448.00 | $2,046.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $921.82 / $1,288.95 / $9,929.00
| Facility | | $921.82 | $1,288.95 | $9,929.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $921.82 / $1,288.95 / $9,929.00
| Professional | | $921.82 | $1,288.95 | $9,929.00 |
- 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
- $759.82 / $1,010.29 / $1,716.86
| Professional | | $759.82 | $1,010.29 | $1,716.86 |