- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,186.21 / $4,264.00 / $8,240.00
| Facility | | $1,186.21 | $4,264.00 | $8,240.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $919.25 / $1,112.00 / $1,441.61
| Professional | | $919.25 | $1,112.00 | $1,441.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,639.91 / $11,851.00 / $28,970.26
| Facility | | $8,639.91 | $11,851.00 | $28,970.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $943.96 / $1,431.51 / $1,909.54
| Professional | | $943.96 | $1,431.51 | $1,909.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $943.88 / $1,329.84 / $2,124.85
| Professional | | $943.88 | $1,329.84 | $2,124.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,280.71 / $1,699.00 / $1,719.24
| Professional | | $1,280.71 | $1,699.00 | $1,719.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,020.00 / $4,761.00 / $8,247.00
| Facility | | $1,020.00 | $4,761.00 | $8,247.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $919.25 / $1,156.68 / $5,100.00
| Professional | | $919.25 | $1,156.68 | $5,100.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.00 / $989.10 / $2,881.40
| Professional | | $5.00 | $989.10 | $2,881.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,030.05 / $1,351.60 / $2,234.42
| Professional | | $1,030.05 | $1,351.60 | $2,234.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $847.20 / $1,071.26 / $1,071.26
| Facility | | $847.20 | $1,071.26 | $1,071.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $847.20 / $1,071.26 / $1,141.95
| Professional | | $847.20 | $1,071.26 | $1,141.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,468.00 / $6,885.00 / $19,040.18
| Facility | | $2,468.00 | $6,885.00 | $19,040.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $821.70 / $1,205.10 / $2,084.61
| Professional | | $821.70 | $1,205.10 | $2,084.61 |