- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,029.46 / $3,745.00 / $8,017.00
| Facility | | $1,029.46 | $3,745.00 | $8,017.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $836.32 / $984.68 / $1,147.06
| Professional | | $836.32 | $984.68 | $1,147.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,058.35 / $6,182.00 / $17,094.48
| Facility | | $5,058.35 | $6,182.00 | $17,094.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,598.30 / $1,658.61 / $1,658.61
| Professional | | $1,598.30 | $1,658.61 | $1,658.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $925.32 / $1,185.08 / $2,088.81
| Professional | | $925.32 | $1,185.08 | $2,088.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,918.94 / $1,918.94 / $1,918.94
| Professional | | $1,918.94 | $1,918.94 | $1,918.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,013.00 / $3,964.00 / $8,017.00
| Facility | | $1,013.00 | $3,964.00 | $8,017.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $931.42 / $1,062.96 / $2,843.00
| Professional | | $931.42 | $1,062.96 | $2,843.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,672.50 / $1,672.50 / $1,672.50
| Professional | | $1,672.50 | $1,672.50 | $1,672.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,262.76 / $1,262.76 / $1,262.76
| Facility | | $1,262.76 | $1,262.76 | $1,262.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $960.02 / $1,227.52 / $2,262.35
| Professional | | $960.02 | $1,227.52 | $2,262.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $710.55 / $710.55 / $781.61
| Facility | | $710.55 | $710.55 | $781.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $710.55 / $710.55 / $781.61
| Professional | | $710.55 | $710.55 | $781.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $637.00 / $2,391.00 / $6,000.00
| Facility | | $637.00 | $2,391.00 | $6,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $934.86 / $1,192.43 / $2,126.71
| Professional | | $934.86 | $1,192.43 | $2,126.71 |