- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,416.00 / $4,304.00 / $8,240.00
| Facility | | $1,416.00 | $4,304.00 | $8,240.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $918.70 / $1,447.91 / $1,807.32
| Professional | | $918.70 | $1,447.91 | $1,807.32 |
- 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
- $1,293.34 / $1,342.15 / $1,342.15
| Professional | | $1,293.34 | $1,342.15 | $1,342.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,034.32 / $1,485.77 / $2,543.26
| Professional | | $1,034.32 | $1,485.77 | $2,543.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,020.13 / $2,020.13 / $2,188.33
| Professional | | $2,020.13 | $2,020.13 | $2,188.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,020.00 / $4,761.00 / $8,247.00
| Facility | | $1,020.00 | $4,761.00 | $8,247.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $918.70 / $1,544.00 / $5,958.00
| Professional | | $918.70 | $1,544.00 | $5,958.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.00 / $1,343.20 / $3,218.00
| Professional | | $10.00 | $1,343.20 | $3,218.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,023.85 / $1,500.62 / $2,493.13
| Professional | | $1,023.85 | $1,500.62 | $2,493.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $956.77 / $1,259.04 / $1,259.04
| Facility | | $956.77 | $1,259.04 | $1,259.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $956.77 / $1,259.04 / $1,337.24
| Professional | | $956.77 | $1,259.04 | $1,337.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,899.00 / $4,564.00 / $8,261.00
| Facility | | $1,899.00 | $4,564.00 | $8,261.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $979.47 / $1,361.80 / $2,560.65
| Professional | | $979.47 | $1,361.80 | $2,560.65 |