- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,168.18 / $5,087.00 / $8,294.00
| Facility | | $1,168.18 | $5,087.00 | $8,294.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $937.45 / $1,075.49 / $1,462.00
| Professional | | $937.45 | $1,075.49 | $1,462.00 |
- 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
- $940.16 / $1,217.51 / $2,012.90
| Professional | | $940.16 | $1,217.51 | $2,012.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,139.22 / $1,152.88 / $4,117.00
| Professional | | $1,139.22 | $1,152.88 | $4,117.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $640.00 / $640.00 / $1,167.61
| Facility | | $640.00 | $640.00 | $1,167.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $935.84 / $1,228.43 / $2,283.28
| Professional | | $935.84 | $1,228.43 | $2,283.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $973.45 / $1,246.02 / $1,467.05
| Professional | | $973.45 | $1,246.02 | $1,467.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,010.80 / $1,314.19 / $1,961.69
| Facility | | $1,010.80 | $1,314.19 | $1,961.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,183.00 / $1,413.85 / $2,013.00
| Professional | | $1,183.00 | $1,413.85 | $2,013.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $908.95 / $1,253.39 / $2,487.64
| Facility | | $908.95 | $1,253.39 | $2,487.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $908.95 / $1,253.39 / $2,487.64
| Professional | | $908.95 | $1,253.39 | $2,487.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,713.00 / $2,863.00 / $5,340.00
| Facility | | $1,713.00 | $2,863.00 | $5,340.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $702.89 / $1,132.50 / $1,976.99
| Professional | | $702.89 | $1,132.50 | $1,976.99 |