- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,278.48 / $4,264.00 / $8,240.00
| Facility | | $1,278.48 | $4,264.00 | $8,240.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $991.00 / $1,200.59 / $1,559.20
| Professional | | $991.00 | $1,200.59 | $1,559.20 |
- 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
- $1,021.26 / $1,554.30 / $2,080.46
| Professional | | $1,021.26 | $1,554.30 | $2,080.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,025.22 / $1,447.09 / $2,304.01
| Professional | | $1,025.22 | $1,447.09 | $2,304.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,383.47 / $1,835.43 / $1,853.97
| Professional | | $1,383.47 | $1,835.43 | $1,853.97 |
- 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
- $991.00 / $1,224.14 / $4,831.00
| Professional | | $991.00 | $1,224.14 | $4,831.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.00 / $1,125.59 / $3,099.20
| Professional | | $5.00 | $1,125.59 | $3,099.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,120.80 / $1,471.57 / $2,408.25
| Professional | | $1,120.80 | $1,471.57 | $2,408.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,015.86 / $1,157.56 / $1,157.56
| Facility | | $1,015.86 | $1,157.56 | $1,157.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,015.86 / $1,157.56 / $1,232.22
| Professional | | $1,015.86 | $1,157.56 | $1,232.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,332.00 / $3,914.00 / $7,000.00
| Facility | | $2,332.00 | $3,914.00 | $7,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $956.06 / $1,354.39 / $2,260.41
| Professional | | $956.06 | $1,354.39 | $2,260.41 |