- 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
- $998.64 / $1,100.73 / $1,367.46
| Professional | | $998.64 | $1,100.73 | $1,367.46 |
- 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
- $859.32 / $1,277.68 / $1,855.44
| Professional | | $859.32 | $1,277.68 | $1,855.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $951.81 / $1,318.65 / $2,021.70
| Professional | | $951.81 | $1,318.65 | $2,021.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,474.08 / $1,474.08 / $1,566.23
| Professional | | $1,474.08 | $1,474.08 | $1,566.23 |
- 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
- $944.11 / $1,172.13 / $4,994.68
| Professional | | $944.11 | $1,172.13 | $4,994.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.00 / $1,389.80 / $2,394.10
| Professional | | $3.00 | $1,389.80 | $2,394.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,014.35 / $1,322.99 / $2,052.91
| Professional | | $1,014.35 | $1,322.99 | $2,052.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $953.63 / $953.63 / $1,034.78
| Facility | | $953.63 | $953.63 | $1,034.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $907.75 / $972.70 / $1,034.78
| Professional | | $907.75 | $972.70 | $1,034.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,029.00 / $7,000.00 / $17,398.83
| Facility | | $3,029.00 | $7,000.00 | $17,398.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $965.71 / $1,301.83 / $2,159.23
| Professional | | $965.71 | $1,301.83 | $2,159.23 |