- 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
- $1,086.66 / $1,207.40 / $1,410.61
| Professional | | $1,086.66 | $1,207.40 | $1,410.61 |
- 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
- $886.71 / $1,319.29 / $2,010.07
| Professional | | $886.71 | $1,319.29 | $2,010.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $982.11 / $1,366.46 / $2,120.36
| Professional | | $982.11 | $1,366.46 | $2,120.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,519.85 / $1,519.85 / $1,615.55
| Professional | | $1,519.85 | $1,519.85 | $1,615.55 |
- 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
- $1,076.66 / $1,246.47 / $5,153.75
| Professional | | $1,076.66 | $1,246.47 | $5,153.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.00 / $1,436.70 / $2,551.40
| Professional | | $3.00 | $1,436.70 | $2,551.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,048.85 / $1,420.18 / $2,255.09
| Professional | | $1,048.85 | $1,420.18 | $2,255.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $983.61 / $983.61 / $1,099.30
| Facility | | $983.61 | $983.61 | $1,099.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $936.93 / $1,003.28 / $1,099.30
| Professional | | $936.93 | $1,003.28 | $1,099.30 |
- 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
- $996.94 / $1,378.25 / $2,155.67
| Professional | | $996.94 | $1,378.25 | $2,155.67 |