- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,161.38 / $5,079.00 / $9,534.00
| Facility | | $1,161.38 | $5,079.00 | $9,534.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,032.05 / $1,158.27 / $1,352.93
| Professional | | $1,032.05 | $1,158.27 | $1,352.93 |
- 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
- $851.54 / $1,266.30 / $1,974.21
| Professional | | $851.54 | $1,266.30 | $1,974.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $943.00 / $1,294.64 / $2,008.92
| Professional | | $943.00 | $1,294.64 | $2,008.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,461.43 / $1,461.43 / $1,551.37
| Professional | | $1,461.43 | $1,461.43 | $1,551.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,298.00 / $5,350.00 / $9,830.00
| Facility | | $1,298.00 | $5,350.00 | $9,830.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $841.20 / $1,165.91 / $4,947.58
| Professional | | $841.20 | $1,165.91 | $4,947.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.00 / $1,313.00 / $2,372.00
| Professional | | $10.00 | $1,313.00 | $2,372.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,001.82 / $1,345.12 / $2,023.46
| Professional | | $1,001.82 | $1,345.12 | $2,023.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $943.72 / $943.72 / $1,108.32
| Facility | | $943.72 | $943.72 | $1,108.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $899.56 / $962.59 / $1,108.32
| Professional | | $899.56 | $962.59 | $1,108.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,440.00 / $3,475.00 / $6,000.00
| Facility | | $1,440.00 | $3,475.00 | $6,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $920.86 / $1,310.75 / $2,056.57
| Professional | | $920.86 | $1,310.75 | $2,056.57 |