- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,036.09 / $3,970.00 / $8,294.00
| Facility | | $1,036.09 | $3,970.00 | $8,294.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $862.62 / $1,206.26 / $1,708.42
| Professional | | $862.62 | $1,206.26 | $1,708.42 |
- 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
- $871.90 / $1,345.64 / $1,991.21
| Professional | | $871.90 | $1,345.64 | $1,991.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $986.24 / $986.24 / $4,716.00
| Professional | | $986.24 | $986.24 | $4,716.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,534.91 / $1,534.91 / $1,534.91
| Facility | | $1,534.91 | $1,534.91 | $1,534.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $916.02 / $1,393.85 / $2,523.31
| Professional | | $916.02 | $1,393.85 | $2,523.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,467.38 / $1,638.03 / $1,950.04
| Professional | | $1,467.38 | $1,638.03 | $1,950.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $870.23 / $1,339.51 / $2,227.21
| Facility | | $870.23 | $1,339.51 | $2,227.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,811.00 / $2,145.56 / $2,777.00
| Professional | | $1,811.00 | $2,145.56 | $2,777.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $919.82 / $1,169.41 / $2,069.11
| Facility | | $919.82 | $1,169.41 | $2,069.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,516.63 / $1,872.26 / $3,190.80
| Professional | | $1,516.63 | $1,872.26 | $3,190.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,303.00 / $9,270.00 / $17,192.00
| Facility | | $6,303.00 | $9,270.00 | $17,192.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,227.91 / $1,667.38 / $2,751.95
| Professional | | $1,227.91 | $1,667.38 | $2,751.95 |