- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,125.32 / $4,926.00 / $8,294.00
| Facility | | $1,125.32 | $4,926.00 | $8,294.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $942.37 / $1,125.32 / $2,038.98
| Professional | | $942.37 | $1,125.32 | $2,038.98 |
- 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
- $942.61 / $1,205.59 / $1,712.51
| Professional | | $942.61 | $1,205.59 | $1,712.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,116.23 / $1,116.23 / $4,716.00
| Professional | | $1,116.23 | $1,116.23 | $4,716.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,680.49 / $1,680.49 / $1,680.49
| Facility | | $1,680.49 | $1,680.49 | $1,680.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $952.70 / $1,254.96 / $2,243.19
| Professional | | $952.70 | $1,254.96 | $2,243.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,176.84 / $1,302.72 / $1,550.86
| Professional | | $1,176.84 | $1,302.72 | $1,550.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $944.67 / $1,226.59 / $1,656.61
| Facility | | $944.67 | $1,226.59 | $1,656.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,393.00 / $1,575.00 / $2,332.85
| Professional | | $1,393.00 | $1,575.00 | $2,332.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,003.22 / $1,318.56 / $7,030.19
| Facility | | $1,003.22 | $1,318.56 | $7,030.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,111.48 / $1,437.74 / $7,030.19
| Professional | | $1,111.48 | $1,437.74 | $7,030.19 |
- 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
- $859.32 / $1,180.11 / $1,993.62
| Professional | | $859.32 | $1,180.11 | $1,993.62 |