- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,044.66 / $1,933.00 / $15,291.00
| Facility | | $1,044.66 | $1,933.00 | $15,291.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $981.04 / $1,098.71 / $1,947.14
| Professional | | $981.04 | $1,098.71 | $1,947.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,665.09 / $3,665.09 / $3,718.57
| Facility | | $3,665.09 | $3,665.09 | $3,718.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,256.74 / $1,917.54 / $2,825.65
| Professional | | $1,256.74 | $1,917.54 | $2,825.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,182.48 / $1,182.48 / $6,025.59
| Facility | | $1,182.48 | $1,182.48 | $6,025.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,193.99 / $1,526.62 / $2,678.95
| Professional | | $1,193.99 | $1,526.62 | $2,678.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,044.66 / $1,455.00 / $2,175.78
| Facility | | $1,044.66 | $1,455.00 | $2,175.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,123.00 / $1,316.00 / $1,376.00
| Professional | | $1,123.00 | $1,316.00 | $1,376.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.00 / $1,394.40 / $2,833.60
| Professional | | $5.00 | $1,394.40 | $2,833.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,183.00 / $12,216.00 / $19,066.00
| Facility | | $3,183.00 | $12,216.00 | $19,066.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $925.59 / $1,296.58 / $2,780.70
| Professional | | $925.59 | $1,296.58 | $2,780.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,992.80 / $19,913.50 / $26,542.00
| Facility | | $5,992.80 | $19,913.50 | $26,542.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7,704.80 / $7,704.80 / $9,182.85
| Professional | | $7,704.80 | $7,704.80 | $9,182.85 |