- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,257.09 / $3,633.00 / $8,920.00
| Facility | | $1,257.09 | $3,633.00 | $8,920.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $926.25 / $1,138.27 / $1,442.75
| Professional | | $926.25 | $1,138.27 | $1,442.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,153.00 / $7,363.00 / $9,410.00
| Facility | | $6,153.00 | $7,363.00 | $9,410.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $993.22 / $1,285.10 / $2,124.67
| Professional | | $993.22 | $1,285.10 | $2,124.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $916.00 / $1,170.82 / $2,212.85
| Professional | | $916.00 | $1,170.82 | $2,212.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $640.00 / $640.00 / $1,224.95
| Facility | | $640.00 | $640.00 | $1,224.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,022.14 / $1,331.24 / $2,438.64
| Professional | | $1,022.14 | $1,331.24 | $2,438.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,036.43 / $1,326.63 / $1,562.54
| Professional | | $1,036.43 | $1,326.63 | $1,562.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,131.58 / $1,425.00 / $2,137.07
| Facility | | $1,131.58 | $1,425.00 | $2,137.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,323.00 / $1,491.00 / $2,069.00
| Professional | | $1,323.00 | $1,491.00 | $2,069.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $978.57 / $1,347.36 / $4,747.25
| Facility | | $978.57 | $1,347.36 | $4,747.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $978.57 / $1,347.36 / $4,747.25
| Professional | | $978.57 | $1,347.36 | $4,747.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,423.00 / $11,074.00 / $21,639.00
| Facility | | $6,423.00 | $11,074.00 | $21,639.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $823.56 / $1,273.53 / $2,111.51
| Professional | | $823.56 | $1,273.53 | $2,111.51 |