- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,020.08 / $2,747.00 / $8,017.00
| Facility | | $1,020.08 | $2,747.00 | $8,017.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,020.08 / $1,146.19 / $1,461.38
| Professional | | $1,020.08 | $1,146.19 | $1,461.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,431.95 / $7,827.00 / $19,139.18
| Facility | | $6,431.95 | $7,827.00 | $19,139.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,149.08 / $1,192.44 / $1,192.44
| Professional | | $1,149.08 | $1,192.44 | $1,192.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,109.08 / $1,485.13 / $2,339.69
| Professional | | $1,109.08 | $1,485.13 | $2,339.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,335.82 / $1,767.16 / $1,771.81
| Professional | | $1,335.82 | $1,767.16 | $1,771.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $954.00 / $3,120.00 / $8,017.00
| Facility | | $954.00 | $3,120.00 | $8,017.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,020.08 / $1,221.71 / $2,954.66
| Professional | | $1,020.08 | $1,221.71 | $2,954.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.00 / $1,257.90 / $2,846.30
| Professional | | $6.00 | $1,257.90 | $2,846.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,124.57 / $1,498.94 / $2,441.35
| Professional | | $1,124.57 | $1,498.94 | $2,441.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,077.52 / $1,117.28 / $1,117.28
| Facility | | $1,077.52 | $1,117.28 | $1,117.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,077.52 / $1,117.28 / $1,167.54
| Professional | | $1,077.52 | $1,117.28 | $1,167.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,447.00 / $3,311.00 / $6,000.00
| Facility | | $1,447.00 | $3,311.00 | $6,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,069.56 / $1,412.29 / $2,326.27
| Professional | | $1,069.56 | $1,412.29 | $2,326.27 |