- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,025.03 / $4,691.00 / $8,294.00
| Facility | | $1,025.03 | $4,691.00 | $8,294.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $923.98 / $1,164.18 / $1,445.90
| Professional | | $923.98 | $1,164.18 | $1,445.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,153.00 / $7,363.00 / $9,410.00
| Facility | | $6,153.00 | $7,363.00 | $9,410.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $861.53 / $1,190.10 / $1,726.42
| Professional | | $861.53 | $1,190.10 | $1,726.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $929.70 / $1,359.76 / $11,515.00
| Professional | | $929.70 | $1,359.76 | $11,515.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $917.36 / $1,284.21 / $2,394.69
| Professional | | $917.36 | $1,284.21 | $2,394.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,142.08 / $1,370.50 / $1,690.28
| Professional | | $1,142.08 | $1,370.50 | $1,690.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $979.42 / $1,330.85 / $1,923.87
| Facility | | $979.42 | $1,330.85 | $1,923.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,292.00 / $1,531.00 / $2,276.30
| Professional | | $1,292.00 | $1,531.00 | $2,276.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $855.36 / $1,120.33 / $4,229.78
| Facility | | $855.36 | $1,120.33 | $4,229.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,004.17 / $1,462.24 / $4,283.00
| Professional | | $1,004.17 | $1,462.24 | $4,283.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,349.00 / $7,061.00 / $12,739.00
| Facility | | $4,349.00 | $7,061.00 | $12,739.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $905.43 / $1,376.28 / $2,332.19
| Professional | | $905.43 | $1,376.28 | $2,332.19 |