- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,029.76 / $3,142.00 / $7,799.00
| Facility | | $1,029.76 | $3,142.00 | $7,799.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $880.92 / $954.09 / $1,385.87
| Professional | | $880.92 | $954.09 | $1,385.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,431.95 / $7,827.00 / $19,139.18
| Facility | | $6,431.95 | $7,827.00 | $19,139.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $950.10 / $985.95 / $985.95
| Professional | | $950.10 | $985.95 | $985.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $878.84 / $2,443.39 / $3,077.00
| Professional | | $878.84 | $2,443.39 | $3,077.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,136.61 / $1,535.06 / $1,963.25
| Professional | | $1,136.61 | $1,535.06 | $1,963.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,020.00 / $3,839.00 / $8,017.00
| Facility | | $1,020.00 | $3,839.00 | $8,017.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $891.03 / $1,048.01 / $3,748.00
| Professional | | $891.03 | $1,048.01 | $3,748.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,066.40 / $1,066.40 / $2,048.10
| Professional | | $1,066.40 | $1,066.40 | $2,048.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $878.84 / $2,443.39 / $3,077.00
| Professional | | $878.84 | $2,443.39 | $3,077.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $947.25 / $947.25 / $981.06
| Facility | | $947.25 | $947.25 | $981.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $924.08 / $947.25 / $1,014.37
| Professional | | $924.08 | $947.25 | $1,014.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,155.00 / $3,475.00 / $6,368.00
| Facility | | $2,155.00 | $3,475.00 | $6,368.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $805.76 / $1,131.38 / $1,784.35
| Professional | | $805.76 | $1,131.38 | $1,784.35 |