- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,179.45 / $5,087.00 / $8,920.00
| Facility | | $1,179.45 | $5,087.00 | $8,920.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $899.40 / $1,040.24 / $1,839.94
| Professional | | $899.40 | $1,040.24 | $1,839.94 |
- 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
- $927.49 / $1,208.53 / $1,662.82
| Professional | | $927.49 | $1,208.53 | $1,662.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,124.94 / $1,124.94 / $4,716.00
| Professional | | $1,124.94 | $1,124.94 | $4,716.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,161.46 / $1,161.46 / $1,161.46
| Facility | | $1,161.46 | $1,161.46 | $1,161.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $978.84 / $1,269.85 / $2,045.61
| Professional | | $978.84 | $1,269.85 | $2,045.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,069.67 / $1,182.27 / $1,407.46
| Professional | | $1,069.67 | $1,182.27 | $1,407.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $937.96 / $1,179.45 / $1,602.42
| Facility | | $937.96 | $1,179.45 | $1,602.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,320.00 / $1,615.73 / $2,400.89
| Professional | | $1,320.00 | $1,615.73 | $2,400.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,068.11 / $1,441.96 / $7,030.19
| Facility | | $1,068.11 | $1,441.96 | $7,030.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,068.11 / $1,441.96 / $7,030.19
| Professional | | $1,068.11 | $1,441.96 | $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
- $854.94 / $1,154.60 / $1,914.15
| Professional | | $854.94 | $1,154.60 | $1,914.15 |