- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,284.45 / $2,663.12 / $4,712.00
| Facility | | $1,284.45 | $2,663.12 | $4,712.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $807.73 / $905.88 / $2,318.21
| Professional | | $807.73 | $905.88 | $2,318.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,591.00 / $4,916.00 / $12,850.00
| Facility | | $1,591.00 | $4,916.00 | $12,850.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $902.38 / $1,576.64 / $6,402.56
| Professional | | $902.38 | $1,576.64 | $6,402.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,163.21 / $1,724.73 / $2,610.39
| Professional | | $1,163.21 | $1,724.73 | $2,610.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $909.15 / $1,464.44 / $2,534.86
| Professional | | $909.15 | $1,464.44 | $2,534.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $887.18 / $1,909.00 / $6,679.00
| Facility | | $887.18 | $1,909.00 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,018.04 / $1,233.18 / $1,687.59
| Professional | | $1,018.04 | $1,233.18 | $1,687.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,105.09 / $2,190.75 / $2,889.95
| Professional | | $1,105.09 | $2,190.75 | $2,889.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,997.65 / $11,997.65 / $11,997.65
| Facility | | $11,997.65 | $11,997.65 | $11,997.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,414.95 / $6,414.95 / $6,414.95
| Professional | | $6,414.95 | $6,414.95 | $6,414.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,324.00 / $5,097.00 / $26,542.00
| Facility | | $2,324.00 | $5,097.00 | $26,542.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $966.79 / $1,630.03 / $6,402.56
| Professional | | $966.79 | $1,630.03 | $6,402.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,324.00 / $5,097.00 / $10,764.00
| Facility | | $2,324.00 | $5,097.00 | $10,764.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $966.00 / $1,427.62 / $2,925.88
| Professional | | $966.00 | $1,427.62 | $2,925.88 |