- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,182.76 / $5,087.00 / $10,767.00
| Facility | | $1,182.76 | $5,087.00 | $10,767.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,006.72 / $1,102.72 / $1,485.10
| Professional | | $1,006.72 | $1,102.72 | $1,485.10 |
- 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
- $974.52 / $1,246.20 / $2,060.34
| Professional | | $974.52 | $1,246.20 | $2,060.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,164.76 / $1,186.33 / $5,113.00
| Professional | | $1,164.76 | $1,186.33 | $5,113.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $640.00 / $640.00 / $1,197.05
| Facility | | $640.00 | $640.00 | $1,197.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,036.38 / $1,413.65 / $2,308.55
| Professional | | $1,036.38 | $1,413.65 | $2,308.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,011.10 / $1,294.21 / $1,525.95
| Professional | | $1,011.10 | $1,294.21 | $1,525.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,102.72 / $1,384.39 / $1,961.38
| Facility | | $1,102.72 | $1,384.39 | $1,961.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,313.00 / $1,485.10 / $2,460.10
| Professional | | $1,313.00 | $1,485.10 | $2,460.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,023.69 / $1,345.84 / $3,512.00
| Facility | | $1,023.69 | $1,345.84 | $3,512.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,023.69 / $1,345.84 / $3,512.00
| Professional | | $1,023.69 | $1,345.84 | $3,512.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,651.00 / $6,870.00 / $12,739.00
| Facility | | $3,651.00 | $6,870.00 | $12,739.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $866.25 / $1,299.53 / $2,022.38
| Professional | | $866.25 | $1,299.53 | $2,022.38 |