- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,876.82 / $5,048.00 / $11,025.00
| Facility | | $1,876.82 | $5,048.00 | $11,025.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $992.36 / $1,240.30 / $1,567.65
| Professional | | $992.36 | $1,240.30 | $1,567.65 |
- 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
- $1,008.20 / $1,269.78 / $1,804.48
| Professional | | $1,008.20 | $1,269.78 | $1,804.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,151.65 / $1,175.68 / $2,600.76
| Professional | | $1,151.65 | $1,175.68 | $2,600.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $610.00 / $1,210.81 / $3,282.37
| Facility | | $610.00 | $1,210.81 | $3,282.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $968.80 / $1,348.77 / $2,263.30
| Professional | | $968.80 | $1,348.77 | $2,263.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,009.17 / $1,246.61 / $1,800.70
| Professional | | $1,009.17 | $1,246.61 | $1,800.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,106.08 / $1,409.60 / $2,137.57
| Facility | | $1,106.08 | $1,409.60 | $2,137.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,305.00 / $1,498.00 / $2,452.00
| Professional | | $1,305.00 | $1,498.00 | $2,452.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,081.06 / $1,338.52 / $2,515.56
| Facility | | $1,081.06 | $1,338.52 | $2,515.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,081.06 / $1,338.52 / $2,515.56
| Professional | | $1,081.06 | $1,338.52 | $2,515.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,745.00 / $10,466.00 / $21,401.00
| Facility | | $1,745.00 | $10,466.00 | $21,401.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $850.79 / $1,280.43 / $2,040.08
| Professional | | $850.79 | $1,280.43 | $2,040.08 |