- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,212.42 / $4,264.00 / $8,240.00
| Facility | | $1,212.42 | $4,264.00 | $8,240.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $959.92 / $1,141.67 / $1,487.43
| Professional | | $959.92 | $1,141.67 | $1,487.43 |
- 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
- $976.30 / $1,498.74 / $2,003.90
| Professional | | $976.30 | $1,498.74 | $2,003.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,015.17 / $1,382.48 / $2,222.38
| Professional | | $1,015.17 | $1,382.48 | $2,222.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,319.09 / $1,749.98 / $1,763.65
| Professional | | $1,319.09 | $1,749.98 | $1,763.65 |
- 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
- $959.92 / $1,209.21 / $5,100.00
| Professional | | $959.92 | $1,209.21 | $5,100.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.00 / $1,317.10 / $2,929.10
| Professional | | $5.00 | $1,317.10 | $2,929.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,078.85 / $1,424.85 / $2,283.81
| Professional | | $1,078.85 | $1,424.85 | $2,283.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,009.50 / $1,102.67 / $1,102.67
| Facility | | $1,009.50 | $1,102.67 | $1,102.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,009.50 / $1,102.67 / $1,171.19
| Professional | | $1,009.50 | $1,102.67 | $1,171.19 |
- 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
- $895.33 / $1,310.23 / $2,155.71
| Professional | | $895.33 | $1,310.23 | $2,155.71 |