- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,215.05 / $4,761.00 / $8,451.00
| Facility | | $1,215.05 | $4,761.00 | $8,451.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $865.54 / $1,077.81 / $1,457.80
| Professional | | $865.54 | $1,077.81 | $1,457.80 |
- 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
- $953.12 / $1,395.53 / $1,879.54
| Professional | | $953.12 | $1,395.53 | $1,879.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $911.18 / $1,325.20 / $2,115.66
| Professional | | $911.18 | $1,325.20 | $2,115.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,300.08 / $1,724.77 / $1,753.44
| Professional | | $1,300.08 | $1,724.77 | $1,753.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,151.00 / $5,342.00 / $9,617.00
| Facility | | $1,151.00 | $5,342.00 | $9,617.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $865.54 / $1,133.36 / $3,047.49
| Professional | | $865.54 | $1,133.36 | $3,047.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.00 / $915.40 / $2,973.70
| Professional | | $5.00 | $915.40 | $2,973.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,019.38 / $1,341.01 / $2,268.10
| Professional | | $1,019.38 | $1,341.01 | $2,268.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $894.78 / $1,086.23 / $1,086.23
| Facility | | $894.78 | $1,086.23 | $1,086.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $894.78 / $1,086.23 / $1,163.03
| Professional | | $894.78 | $1,086.23 | $1,163.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,718.00 / $3,752.00 / $7,000.00
| Facility | | $1,718.00 | $3,752.00 | $7,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $863.13 / $1,234.05 / $2,104.52
| Professional | | $863.13 | $1,234.05 | $2,104.52 |