- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,020.00 / $3,839.00 / $8,247.00
| Facility | | $1,020.00 | $3,839.00 | $8,247.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,112.20 / $1,190.09 / $1,491.07
| Professional | | $1,112.20 | $1,190.09 | $1,491.07 |
- 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
- $935.88 / $1,393.92 / $2,025.31
| Professional | | $935.88 | $1,393.92 | $2,025.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $995.60 / $1,355.33 / $2,135.63
| Professional | | $995.60 | $1,355.33 | $2,135.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,603.18 / $1,603.18 / $1,704.42
| Professional | | $1,603.18 | $1,603.18 | $1,704.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,126.39 / $6,126.39 / $6,126.39
| Facility | | $6,126.39 | $6,126.39 | $6,126.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,152.10 / $1,152.10 / $1,152.10
| Professional | | $1,152.10 | $1,152.10 | $1,152.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $832.00 / $4,761.00 / $8,247.00
| Facility | | $832.00 | $4,761.00 | $8,247.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,030.81 / $1,278.70 / $5,442.54
| Professional | | $1,030.81 | $1,278.70 | $5,442.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.00 / $874.80 / $2,608.69
| Professional | | $10.00 | $874.80 | $2,608.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,027.90 / $1,360.61 / $2,135.63
| Professional | | $1,027.90 | $1,360.61 | $2,135.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $934.70 / $1,039.49 / $1,039.49
| Facility | | $934.70 | $1,039.49 | $1,039.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $934.70 / $1,039.49 / $1,084.30
| Professional | | $934.70 | $1,039.49 | $1,084.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $435.00 / $1,305.00 / $3,742.00
| Facility | | $435.00 | $1,305.00 | $3,742.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $944.32 / $1,331.59 / $2,193.44
| Professional | | $944.32 | $1,331.59 | $2,193.44 |