- 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
- $910.37 / $1,055.79 / $1,232.33
| Professional | | $910.37 | $1,055.79 | $1,232.33 |
- 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
- $777.95 / $1,150.11 / $1,671.81
| Professional | | $777.95 | $1,150.11 | $1,671.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $862.40 / $1,207.39 / $1,859.45
| Professional | | $862.40 | $1,207.39 | $1,859.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,340.25 / $1,340.25 / $1,418.67
| Professional | | $1,340.25 | $1,340.25 | $1,418.67 |
- 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
- $850.81 / $1,081.34 / $4,512.38
| Professional | | $850.81 | $1,081.34 | $4,512.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.00 / $1,177.80 / $2,171.30
| Professional | | $3.00 | $1,177.80 | $2,171.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $918.86 / $1,214.61 / $1,873.54
| Professional | | $918.86 | $1,214.61 | $1,873.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $860.68 / $860.68 / $940.59
| Facility | | $860.68 | $860.68 | $940.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $820.89 / $877.89 / $940.59
| Professional | | $820.89 | $877.89 | $940.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,304.00 / $4,584.00 / $9,631.00
| Facility | | $2,304.00 | $4,584.00 | $9,631.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $873.63 / $1,181.82 / $1,808.79
| Professional | | $873.63 | $1,181.82 | $1,808.79 |